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Biographical entry Kocher, Theodor (1841 - 1917)

Hon FRCS July 25th 1900; MD Berne 1865.

Born
1841
Berne, Switzerland
Died
27 July 1917
Occupation
General surgeon

Details

Theodor Kocher, a native of Berne, is remarkable in having remained in his native place throughout his life. Born in 1841, he graduated at the University of Berne in 1865 and studied further in Vienna and in Berlin, and he also visited London and Paris. Following G A Luecke he was appointed Professor of Clinical Surgery in 1872, and was Chief of the Surgical Clinic for forty-five years. He continued in good health and in full activity generally and professorially, as a man far younger than his age, until a serious illness from which he so far recovered as to resume some surgical work in 1917. But in July of that year he was seized with ileus, operated upon, and died two days later on July 27th, 1917.

Kocher early reached the first rank as a surgeon, and retained his position throughout life. His clinic was the resort of all who wished to see general surgery carried out by the most advanced methods. Beginning from the standpoint of applied anatomy in relation to dislocation of the shoulder, in Luecke's theatre a case of old-standing dislocation was submitted to every procedure in vain until Kocher was allowed to try and reduce the dislocation. In later years, after the introduction of X-ray photography, he ardently followed up the development and employed it for the more accurate diagnosis of fractures and dislocations, as well as for the more exact reductions.

After the International Congress of 1881 in London, Kocher became the chief advocate of Lister's methods in Switzerland. Sir Spencer Wells performed ovariotomy in Switzerland with success for the first time in 1882; Kocher followed him. Later he gradually changed to aseptic methods. His most original work was the demonstration, along with Reverdin, that when operating for goitre the removal of the whole thyroid gland which had become possible through the adoption of Listerism was followed by cachexia strumipriva, and this was confirmed experimentally by Schiff, of Geneva, on dogs and rodents, and by Victor Horsley on monkeys. Placed at the centre of endemic thyroid disease, Kocher developed and continually improved upon the details of removal of goitre in all its forms, including the more intimate study of exophthalmic goitre. By 1912 he had performed 5000 goitre operations; general anaesthesia was replaced by local anaesthesia, and Kocher operated at a remarkably uniform, yet really rapid rate.

With antisepsis came the operation for the cure of hernia by incision; at first he inverted the sac as in his previous subcutaneous operation, then the ligature of the neck at its junction with the peritoneal cavity and the removal of the sac. His method of suturing was superseded by that of Bassini. He devised a modification of the original Billroth's procedures for cancer of the stomach, but it had not a very wide application. He introduced a submaxillary operation for cancer of the tongue, later he rather reverted to the median Syme's operation. But the Butlin method of a dissection of the neck to remove the glands earliest invaded was wider, and on the other hand caused less injury to the rest of the tongue and jaw. The great advantage of the original operation was the preliminary ligature of the lingual artery.

Kocher's monograph on intracranial pressure is remarkable for the amount of research included in it. The onset of a general epileptic fit had been usually ascribed to an anaemia of the affected convolutions of the cortex. Kocher suggested the reverse - a temporary congestion - and that trephining might set up an anastomosis between the intracranial circulation and that of the scalp. He frequently visited the chief centres of surgery, and was well known in London as a perfect linguist in the three languages - German, French, and English. He exhibited a pleasant, humorous, unassuming courtesy, whether in his clinic, in his house, or abroad. To all surgical students he became well known through his Chirurgische Operationslehre, first published in 1892, with 162 illustrations, translated by Harold Stiles in 1895; by 1911 there had appeared the fifth German edition and the corresponding revised translation. As the first surgeon of his day, he was President of the German Society of Surgery in 1902, again of the first meeting of the International Surgical Society at Brussels in 1905, and in 1911 he received the Nobel Prize for Surgery.

Publications:
Behandlung der croupösen Pneumonie mit Veratrum Präparaten, Würzburg, 1866. This was his one medical contribution.
"Die Analogien von Schulter und Hüft-Gelenk Luxationen und ihrer Repositions¬methoden." - Volkmann's Sammlung klin Vortr, 1875, No 83, Chir No 27, p611.
"Die Lister'sche Behandlung bei der Ovariotomie." - Cor-Blatt f schweiz Aerzie, 1875, v, 393.
"Ueber Kropfextirpation und ihre Folgen." - Arch f klin Chir, 1883, xxix, 254.
"Die Hernien im Kindesalter." - Gerhardt's Handbuch der Kinderkrankh, 1889, vi, 2 abtheil, 699.
"Zur Radicalcur der Hernien." - Cor-Blatt f schweiz Aerzie, 1892, xxii, 561.
"Die Oesophagusdivertikel und dessen Behandlung." - Ibid, 233.
"Hirnerschütterung, Hirndruck und Chirurgische Eingriffe bei Hirnkrankheiten." - Nothnagel Sp Pathol u Therap, 1901, ix Bd, III Th, II abtheil.
Chirurgische Operationslehre, 1892; 5th ed 1907. Translation by Harold Stiles, 1895, from 2nd German edition; 1911, from 5th German edition.

Sources used to compile this entry: [Brit Med Jour,1917, ii, 138 (Moynihan and Lynn Thomas). Arch f klin Chir, 1921, cxv, p.v (Dr Albert Vogel, Berne). "Festschrift Herrn Professor Th Kocher zur Feier seiner vierzigjährigen Lehrtätigkeit von seinen Schülerngewidmet, Deut Zeits f Chir, 1912, cxvi].

The Royal College of Surgeons of England