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Emil Theodor Kocher: a name synonymous with thyroid surgery
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The contributions of Emil Theodor Kocher dramatically changed the field of thyroid surgery.
The Swiss surgeon has been described as the world leader in thyroid surgery during the end of the 19th century. He is credited with significantly decreasing thyroid-related operative mortality and was appointed professor of surgery at the age of 31 — a position he held until he retired. His major discoveries in the pathology, physiology and surgery of the thyroid gland earned him the Nobel Prize in 1909 — the first ever awarded to a surgeon.
Thyroid gland advances
Goiter was a significant medical problem in Bern, Switzerland, where Kocher lived and worked, until the iodination of salt became customary, according to published reports.
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Source: National Library of Medicine |
In 1883, Kocher was the first to describe the effects of partial and total thyroidectomy while at the University Clinic in Bern. His fascination with the thyroid gland began in 1874 with an 11-year-old girl who became cretinoid after a successful total thyroidectomy. Total ablation of the thyroid gland produced marked changes in intelligence and physical growth and produced symptoms such as swollen hands, puffy face and anemia. The girl’s cretinoid state prompted Kocher to reinvestigate all of his thyroid patients. He discovered that nearly all of them had symptoms of hypothyroidism, or, as he called it, “cachexia strumipriva.” At the time, Kocher did not realize the pattern was related to total exclusion of the thyroid gland, but this finding made him wary to perform total ablation of the gland in future patients. He turned to other methods, including transplantation and introduction of parenteral and oral therapy, which was later used as the standard treatment for thyroid deficiency.
Kocher’s finding resulted in a rapid increase in thyroidectomies. In fact, he was credited with performing about 2,000 of these surgeries in his clinic by 1901. When he died in 1917, more than 7,000 thyroidectomies had been performed in his clinic. His advances played a major role in decreasing the mortality rate associated with thyroid surgery. In the 1850s, the mortality rate was roughly 40%. In 1883, the mortality rate for Kocher’s patients was 13% — and this dropped to less than 1% at the end of the 19th century.
Goiter removal previously had been difficult and dangerous, but “Kocher became so proficient that he could remove the whole of the thyroid gland without the patient dying,” according to an article.
A man of many discoveries
Kocher remained in Bern for the length of his medical career. He obtained his doctorate in 1865, was an assistant to George Albert Lücke at the University Clinic in Bern and quickly succeeded him as professor of surgery and director of the University Surgical Clinic in 1872.
He had a keen interest in preventing surgical infections. At one point, he conducted infection control classes for military doctors. In addition to thyroidology, Kocher made significant contributions to fields of surgery. He studied osteomyelitis and its relationship with chronic staphylococcus, discovered a new method to reduce dislocations of the shoulder, and investigated mobilization of the duodenum and other abdominal organs to explore the inferior caval vein and pancreas — today called Kocher’s maneuver. He also studied and published scientific papers on hernias, traumatic epilepsy, brain damage, orthopedics and trepanation.
Outside of the hospital, Kocher published a textbook about his theory on surgical operations, Chirurgische Operationslehre (1892), which was published in six editions and several languages.
His physiological approach to surgery set him apart from other early surgeons. During his time, Kocher had a remarkable relationship with two of the leading American surgeons during the 19th century: Harvey Cushing, MD, and William Halsted, MD. According to published reports, Cushing once said: “[Halsted and Kocher] were engaged in similar problems; they were friends and correspondents; they were equally fastidious in their operative craftsmanship and at the same time, by precept and example, exerted a profound influence as investigators on the scientific aspects of their art. They represented European and American surgery of their day at its very best.”
Many operating rooms still pay homage to Kocher today; he developed forceps and incision tools that remain in general use.
Kocher died in Bern in 1917, but not before his oldest son, Albert, also became assistant professor of surgery and helped his father with his work. Today, the contributions of Kocher live on, and he is remembered with the Theodor Kocher Institute, Kochergasse and Kocher Park. – by Katie Kalvaitis
For more information:
- Andrén-Sandberg A, Mai G. Theodor Kocher (1841-1917) — a surgical maestro. Dig Surg. 2001;18:311-316.
- Fulton JF. Arnold Klebs and Harvey Cushing at the 1st International Neurological Congress at Berne in 1931. Int J Neurol. 1980;14:103-115.
- Kocher T. Concerning pathological manifestations in low-grade thyroid disease. The Nobel Prize website. http://nobelprize.org/nobel_prizes/medicine/laureates/1909/kocher-lecture.pdf. Accessed July 7, 2008.
- Schlich T. Changing disease identities: cretinism, politics and surgery (1844-1892). Medical History. 1994;38:421-443.