World of Anatomy and Physiology on Emil Theodor Kocher
In 1870s Switzerland, goiter was a common ailment, usually marked by a glandular swelling on the front of the neck. In later years it would be understood that a simple iodine supplement to the diet could significantly reduce the disorder. But in the nineteenth century, surgical removal of the thyroid gland was the only known cure. However, in the absence of effective anesthetics and antisepsis, surgical attempts to remove a goiter meant almost certain death for the patient. This was the challenge faced by Swiss surgeon Theodor Kocher, who devoted his medical career to making thyroidectomy, or the removal of a thyroid gland, a relatively safe procedure by applying new notions of antisepsis. Kocher performed thousands of thyroidectomies in his career, and the post-operative research and data he collected helped amass new knowledge about the physiology of the thyroid gland and its related disorders. For his many contributions to medicine, and especially the treatment of goiter, Kocher received the Nobel Prize in medicine in 1909.
Emil Theodor Kocher was born the son of Jacob Alexander and Maria (Wermuth) Kocher, in Bern, Switzerland. His father was an engineer and his mother a descendant of the Moravian Brethren. She passed on to her son a deeply religious philosophy that would help him gain an empathetic understanding of his patients in years to come. Schooled in Berlin, Germany; London, England; Paris, France; and Vienna, Austria, Kocher received his M.D. from the University of Bern in 1869. That same year he married Marie Witschi-Courant--the couple would have three sons. Newly married and newly graduated from medical school, Kocher visited various European clinics, including one in Vienna, where he studied under the most famous European surgeon of the day, Theodor Billroth. In 1872, Kocher, who was only thirty-one years old at the time, was named professor of clinical surgery at Bern University, a post he would hold for the next forty-five years.
Kocher first gained recognition for developing a method for treating a dislocated shoulder, a technique now known by his name. Subsequently, he also created new methods or improvements in existing methods for operations upon the lungs, stomach, gall bladder, intestine, cranial nerves, and hernia. He also developed a special pair of surgical forceps, now known as "Kocher's forceps," instruments that were used for many years after his death. Despite his many successes and contributions that improved surgical procedures, Kocher was open to other suggestions and ideas. "It is an indication of his scientific objectivity that he was always ready to abandon any of his own techniques or gadgets in favor of improvements introduced by other surgeons," Theodore L. Sourkes has written in Nobel Prize Winners in Medicine and Physiology. The example Sourkes provides is Kocher's ready abandonment of his own style of surgically correcting hernia's in favor of another approach.
Kocher further contributed to medicine with his Textbook of Operative Surgery (the book was translated into several languages, including an English edition in 1895), his pioneering of ovariotomy and, especially, his application of the antiseptic techniques of the English researcher and doctor Joseph Lister.
Kocher himself credited his success with thyroidectomy operations in part to Lister's method of antisepsis. He said while receiving his Nobel Prize that it was because of Lister that one of the "most dangerous operations, the removal of the thyroid gland, so often appearing urgently necessary because of severe respiratory disturbances, could be performed without substantial danger." However, despite his mastery over the operation, Kocher himself considered the increased knowledge about the physiological function of the thyroid gland an even greater advancement in medical science. In 1883, at the congress of the German Surgical Society, Kocher reported that out of his first 100 thyroidectomies, 30 had resulted in a serious disorder. This ailment was apparently a result of the whole, rather than partial, removal of the goiter. The symptoms Kocher described were called operative myxedema, and were akin to naturally occurring myxedema. Patients suffering from myxedema usually reported weight gain, slowing of intellect and speech, hair loss, tongue thickening, and abnormal heart rates, as well as developing blood-related problems of anemia and altered white blood-cell counts. Kocher further related that myxedema symptoms were similar to problems experienced by patients suffering from sporadic cretinism and cachexia strumipriva, diseases that resulted in mental retardation and dwarfism. Because of Kocher's postulations, it was discovered that a lack of thyroid secretions was the cause of all these diseases. Kocher further pointed out that hypothyroidism can be traced not only to absence of the gland, whether congenital or surgical, but also to a goiter which has caused the gland to stop working. His descriptions of the thyroid disorder have clarified and brought together a series of medical observations on this subject over the years.
Kocher's observations also opened the way for future treatment of thyroid disorders. Although initial attempts to rectify the condition by administering thyroid hormone were not particularly successful, researchers recognized the importance of iodine, and in 1914 the effective part of the hormone, thyroxin, was isolated for effective treatment. Meanwhile, Kocher helped perfect surgical technique for thyroidectomy, and his surgical mortality rates dropped by a great margin over the years.
During his long surgical career Kocher performed more than 2,000 thyroidectomies. In time the need for the operation declined as iodine-deprived regions, like the "goiter belt" of the Great Lakes area in the United States and certain parts of Switzerland, incorporated supplements into their diets. Nevertheless, Kocher's contributions to combating endemic goiter continue to be recognized in a world where nearly five percent of the population still continues to suffer this disorder.
Kocher died in Bern eight years after winning the Nobel. While placing a wreath on his tomb, American neurosurgeon Harvey Cushing said in a speech at the First International Neurological Congress in 1931, "From hard work and responsibility surgeons are prone to burn themselves out comparatively young, but Kocher had been blessed with an imperturbility of spirit or had cultivated these habits of self-control which enabled him to bear his professional labors, his years, and his honors with equal composure to the very end."
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