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Emil Theodor Kocher: Innovative Surgeon

Shampo, Marc A. PhD

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The Swiss surgeon Emil Theodor Kocher (1841–1917) received the 1909 Nobel Prize in physiology or medicine for his work on the thyroid gland. This innovative work eventually resulted in effective treatment of thyroid disorders not only by the use of surgery but also by the use of such drugs as thyroid extract and thyroxin.

Marc A. Shampo, PhD, Mayo Clinic, 200 1st Street SW, Plummer 10, Rochester, MN 55905

The Swiss surgeon Emil Theodor Kocher made innumerable contributions to techniques in many surgical procedures, including operations on the lungs, stomach, and gallbladder. Especially important was his pioneering of ovariotomy and the application of antiseptic surgery, introduced by Joseph Lister (1827–1912).

The surgical success of Kocher depended greatly on the many improvements he made in appliances and instruments. However, despite his versatility and creativity in surgery, Kocher is best known for his work on the physiology, pathology, and surgery of the thyroid gland, for which he was awarded the Nobel Prize for physiology or medicine in 1909. Kocher established not only the function of the thyroid gland but also the cause of cretinism and myxedema.

Through his innovative work, he provided an understanding of the thyroid gland in toxic and nontoxic goiter. He developed an operative technique that reduced the mortality rate from 12.8% in the first series of patients to less than 0.2% (1 death in a series of 600 patients).

Kocher, the second son of an engineer, was born on August 25, 1841, in Bern in west central Switzerland. The deeply religious Kocher family consisted of six children (five boys and one girl). Kocher spent his early youth in Burgdorf (approximately 10 miles northeast of Bern), where he attended the Realschule (middle school) and Literargymnasium (secondary school).

Academically, he was always at the top of his class. In the spring of 1860, he completed his examinations, graduated, and then enrolled at the Bern Hochschule (University of Bern). In 1865, he received his medical degree from the University of Bern. He went on to surgical internships and residencies at the universities of Berlin, London (where he worked with Lister), Paris, and Vienna (where he was a surgical resident to the famous Austrian surgeon Theodor Billroth, 1829–1894). From the winter of 1863 to the winter of 1869, Kocher served as assistant chief physician in a children’s hospital in Bern.

In 1872, Kocher was appointed professor of clinical surgery at the University of Bern and director of the University Surgical Clinic. He retired from surgery in 1911 but remained associated with the University and the Clinic for 45 years until his death in 1917. For many years, his clinic was a mecca for visiting surgeons from all over the world.

At the University of Bern, he was the first surgeon to excise the thyroid gland for the treatment of goiter (1876). He performed this difficult operation more than 2000 times, with only 4.5% mortality; in practice, he adopted the principle of complete asepsis introduced by Joseph Lister. He also investigated gunshot wounds from small-caliber bullets (1895) and was one of the first surgeons to successfully resect and unite the intestines.

He was a pioneer in surgery of the abdomen. He applied experimental surgery to the physiology of the brain. For treatment of certain injuries and diseases of the brain, he developed the technique of trephination, which involves the surgical removal of a small section of the skull to relieve intracranial pressure.

In 1883, he discovered a characteristic cretinoid pattern in patients after total excision of the thyroid gland; however, when part of the gland was left in place, there was only a transitory sign of the pathological pattern. By 1912, he had performed more than 5000 thyroid excisions and had reduced the mortality in such operations from 18% to less than 0.5%.

Kocher also studied lesions of the spinal cord. In 1917, he conceived the idea of injecting a sterile preparation that he called “coagulum” (from blood platelets), which he used to stop blood flow from wounds and to accelerate coagulation in internal hemorrhage.

Kocher published numerous studies, and his classic book, Textbook of Operative Surgery (1894), went through six editions, was translated into many languages, and served as a standard textbook in Europe and the United States for years. In 1905, he was president of the First Surgical Congress, held in Brussels, Belgium, and he was a member of the German Society of Surgery.

Kocher’s name is associated with:

  • a method of excising the ankle joint by a cut below the outer malleolus, division of the peroneal tendons, removal of the diseased tissues, and suturation of the divided tendons;
  • a procedure for removing the thyroid gland by one median incision and two lateral ones, the latter being carried upward almost to the angle of the jaw;
  • a method of reducing a subcoracoid dislocation of the humerus;
  • surgery to excise the tongue through an incision extending from the symphysis of the jaw to the hyoid bone and to the mastoid process;
  • a technique of mobilizing the duodenum (Kocher maneuver) for exposure of the retroduodenal, intrapancreatic, and intraduodenal portions of the common bile duct; and
  • a method of pylorectomy.

Also named for Kocher is a strong forceps with sharp points at the tip and transverse serrations along the full length used for holding tissues during an operation or for compressing bleeding tissues (Kocher forceps). “Kocher’s incision” is a subcostal incision that, when made on the right, provides exposure of the gallbladder and common bile duct and, when made on the left, provides exposure for splenectomy or splenorenal-renal anastomosis. In determining Graves’ disease, the examiner places his or her hand on a level with the patient’s eyes and then lifts the hand higher. In the patient with Graves’ disease, the upper lid springs up more quickly than does the eyeball; this symptom has been named “Kocher’s sign.” A contraction of the abdominal muscle on compression of the testicle is labeled “Kocher’s reflex.”

On July 25, 1917, Kocher lapsed into a coma. He died in Bern 2 days later, on July 27, at the age of 75 years. His work on the thyroid gland provided a critical stimulus to research on that gland, particularly in search of therapeutic treatment—treatment that led to the introduction of such valuable drugs as thyroid extract and thyroxin.

In 1967, the Swiss Postal Administration marked the 50th anniversary of his death with a postage stamp (Scott No. B365) bearing his portrait (Fig. 1). In 1969, Sweden issued its annual set of stamps honoring Nobel Prize winners who received the prize 60 years earlier. Two of the stamps (Scott Nos. 842, 845) show portraits of Kocher and another 1909 winner, Friedrich Wilhelm Ostwald, winner in chemistry for “his work on catalysis and on the conditions of chemical equilibrium and velocities of chemical reactions” (Fig. 2). Kocher also was honored on a stamp (Scott No. 2116e) issued by the Maldive Islands in 1955. The stamp is one on a sheet honoring Nobel Prize winners.

Figure 1

Figure 1

Figure 2

Figure 2

Marc A. Shampo, PhD

Emeritus Member

Section of Scientific Publications

Mayo Clinic and Mayo Foundation

Rochester, Minnesota

© 2001 Lippincott Williams & Wilkins, Inc.