Emil Theodor Kocher

Biography of Emil Theodor Kocher

Emil Theodor Kocher won the 1909 Nobel Prize in Physiology or Medicine for his work on the physiology, pathology and surgery of the thyroid gland. Kocher has given his name to the Kocher Institut in Bern.

Kocher studied in Zurich, Berlin, London, Paris and Vienna, a student of Theodor Billroth (1829-1894) and Bernhard von Langenbeck (1810-1887). Kocher received his medical doctorate in Bern in 1865. Following en educational journey abroad he was assistant with professor Georg Albert Lücke (1829-1884) in the surgical clinic in Bern, where Lücke operated on 10 patients with goitre and 9 died. He succeeded Lücke as professor of surgery in Bern in 1872 and in 1874 published his first 13 goitre operations with only 2 deaths. He did much experimental work on the thyroid gland and was the first to excise the thyroid for goitre in 1876.

In 1883 Kocher announced his discovery of a cretinoid pattern in patients after total excision of the thyroid gland¸ when a portion of the gland was left intact, however, there were only transitory signs of the pathological pattern.

By 1912 Kocher had performed 2.000 thyroid excisions. When he died in 1917 more than 7,000 thyroid operations had been done in his clinic; three quarters by himself. The mortality decreased steadily from 14% in 1884 to 2.4% in 1889 and 0.18% in 1898. Truly remarkable when the era in which he was undertaking the operation is considered. This is to a high degree attributable to Kocher not only being extremely painstaking and careful, at all times a calm and imperturbable operator, but also to his maintaining total sepsis at all times.

Kocher’s other surgical contributions include a method for reducing dislocations of the shoulder and improvements in operations on the stomach, the lungs, the tongue, and cranial nerves, and for hernia. He also devised many new surgical techniques, instruments, and appliances. The forceps and incision i gallbladder surgery that bear his name remain in general use. His textbook on operative surgery, Chirurgische Operationslehre (1892), was published in many editions and translations.

Kocher described myxoedema following thyroidectomy, Cachexia strumipriva, which occurred in 30 out of 100 thyreoidectomies. He undertook much experimental work on animals and was interested in the physiology of the brain and the spinal cord. He evolved a hydrodynamic theory for the effect of gunshot wounds and attempted in 1912 to accelerate haemostasis in internal haemorrhage by injecting a sterile coagulating fluid which had been derived by Anton Fonio (1881-1968) from platelets. He was a complete master of dissection.

Kocher’s methods were somewhat similar to those of Joseph Lister (1827-1912) and William Hallsted (1852-1922) in that he relied on absolute precision and care rather than speed and show, and in this was vindicated by his low mortality figures.

Notably three men, Lister, Hallsted and Kocher, did more to improve operative mortality than any other surgeons of their time and ended the days when surgeons were regarded as good only if they wee quick, rapid and spectacular. In 1909 the Kocher Institute in Bern was established as a permanent memorial to him. He retired as professor of surgery in 1911.

A number of instruments are named for him, among them Kocher’s forceps, Kocher’s probe and Kocher’s glass drains.

We thank Patrick Jucker-Kupper, Switzerland, for information submitted.