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Emil Theodor Kocher

Born  1841
Died  1917

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Swiss surgeon, born August 25, 1841, Bern; died July 27, 1917, Bern.

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.

Bibliography

  • Eine neue Reductionsmethode für Schulterverrenkung.
    Berliner klinische Wochenschirft, 1870, 7: 101-105.
  • Krankheiten des Hodens.
    In Franz Freiherr von Pitha (1810-1875) and Theodor Billroth Billroth (1829-1894): Handbuch der allgemeinen und speziellen Chirurgie. Volume 2. Erlangen and Stuttgart, 1874.
  • Die acute Osteomyelitis.
    Deutsche Zeitschrift für Chirurgie, Leipzig.
  • Zur Lehre von der Brucheinklemmung (mit Aufstellung einer neuen Theorie derselben).
    Deutsche Zeitschrift für Chirurgie, Leipzig.
  • Aetiologie und Therapie des Pes varus.
    Deutsche Zeitschrift für Chirurgie, Leipzig.
  • Chirurgische Beiträge zur Physiologie des Gehirns und Rückenmarks.
    Deutsche Zeitschrift für Chirurgie, Leipzig.
  • Die Verletzungen der Wirbelsäule und des Rückenmarks.
    Grenzgebiete der Medizin.
  • Exstirpation einer Struma retrooesophagea.
    Correspondenz-Blatt für Schweizer Aerzte, Basel, 1878, 8: 702-705.
  • Ueber Radicalheilung des Krebses.
    Deutsche Zeitschrift für Chirurgie, Leipzig, 1880, 13: 134-166.
    Kocher’s operation for radical extirpation of the tongue for carcinoma.
  • Ueber Schusswunden. Experimentelle Untersuchungen über die Wirkungsweise der modernen Klein-Gewehr-Geschosse. Leipzig, 1880.
  • Die antiseptische Wundbehandlung mit schwachen Chlorzinklösungen in der Berner Klinik.
    (Volkmanns) Sammlung klinischer Vorträge, Leipzig, 1881, No. 203-204. 48 pages.
  • Ueber die einfachsten Mittel zur Erzielung einer Wundheilung durch Verklebung ohne Drainröhren.
    (Volkmanns) Sammlun klinischer Vorträge, Leipzig, 1883, 224. 28 pages.
  • Ueber Kropfexstirpation und ihre Folgen.
    [von Langenbeck’s] Archiv für klinische Chirurgie, Berlin, 1883, 29: 254-337.
    Kocher coined the term “cachexia strumipriva” to describe the myxoedema following total extirpation of the thyroid.
  • Die Krankheiten der männlichen Geschlechtsorgane.
    Deutsche Chirurgie. Volume 50 b. Stuttgart, 1887.
  • Eine einfache Methode zur Erzielung sicherer Asepsis.
    Correspondenz-Blatt für Schweizer Aerzte, Basel, 1888, 18: 3-20.
  • Bericht über weitere 250 Kropfexstirpationen.
    Schweizerische Medizinische Wochenschrift (Correspondenz-Blatt für Schweizer Aerzte, Basel) 1889, 19:33-44.
  • Chirurgische Klinik von Prof. Dr. Kocher zu Bern.
    Sommersemester 1891 edited by Otto Lanz and Fritz de Quervain. Jena 1891.
    It is an edited version of the clinical colloquia held by Theodor Kocher during the summer semester of 1891.
  • Zur Radicalcur der Hernien.
    Korrespondenz-Blatt für Schweizer Ärzte, Basel, 1892, 22: 561-576.
    Kocher’s hernia operation.
  • Chirurgische Operationslehre.
    Jena, 1892; 5th edition, 1907; translated into English, French, Italian, Russian, and Spanish.
  • Verhütung des Cretinismus und cretinoider Zustände.
    Deutsche Zeitschrift für Chirurgie, Leipzig.
  • Vorlesungen über chirurgische Infektionskrankheiten.
    With Ernst Tavel (1858-1912). 1. T. Basel, 1895. 2. T., Jena, 1909.
  • Beiträge zur Kenntnis eininger praktisch wichtiger Fracturformen.
    Jena, 1896; translated into French.
  • Enzyklopädie der Chirurgie.
    With Fritz de Quervain. 2 volumes; Jena, 1901-1903.
We thank Rudolf Kleinert, Bad Reichenhall, Germany; and Patrick Jucker-Kupper, Switzerland, for information submitted.

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