Emil Theodor Kocher, Nobel Prize in Physiology or Medicine, 1909

Emil Theodor Kocher (25 August 1841 – 27 July 1917) was a Swiss physician and medical researcher who received the 1909 Nobel Prize in Physiology or Medicine for his work in the physiology, pathology and surgery of the thyroid. Among his many accomplishments are the introduction and promotion of aseptic surgery and scientific methods in surgery, specifically reducing the mortality of thyroidectomies below 1% in his operations.

He was the first Swiss citizen and the first surgeon to ever receive a Nobel prize. He was considered a pioneer and leader in the field of surgery in his time.

Early Life and Personal life

Childhood'

Kocher's father was Jakob Alexander Kocher (1814-1893),[4] the sixth of seven children to Samuel Kocher (1771-1842), a carpenter, and Barbara Sutter (1772-1849). Jakob Alexander Kocher was a railway engineer and he moved in 1845 to Burgdorf, Switzerland (near Bern) because of his job as regional engineer of Emmental (Bezirksingenieur).[5] He was named chief engineer for street and water in the canton of Bern at an age of only 34 years and he moved with his family to the capital, the city of Bern. In 1858 he left the states service and managed several engineering projects around Bern.

Theodor Kocher's mother was Maria Kocher (née Wermuth)[2] living from 1820 to 1900.[5] She was a very religious woman and part of the Moravian Church; together with Jakob Alexander, she raised a family of five sons and one daughter (Theodor Kocher was the second son).

Theodor Kocher was born on 25 August 1841 in Bern and baptized in the local Bern Minster on 16 September 1841. Together with the family, he moved to Burgdorf in 1845 where he started school. Later his family moved back to Bern where he went to middle and high school (Realschule and Literaturgymnasium) where he was the first of his class.[5] During high school, Theodor was interested in many subjects and was specifically drawn to art and classical philology but finally decided to become a doctor.

Studies

He started his studies after obtaining the Swiss Matura in 1858 at the University of Bern where Anton Biermer and Hermann Askan Demme were teaching, two professors that impressed him most. He was a studious and dedicated student but still became a member of the Schweizerischer Zofingerverein, a Swiss fraternity. He obtained his doctorate in Bern in 1865 (March 1865) or 1866 with his dissertation about Behandlung der croupösen Pneumonie mit Veratrum-Präparaten (literal English translation: The treatment of croupous pneumonia with Veratrum preparations.) under professor Biermer with the predicate summa cum laude unamimiter.

In spring 1865, Kocher followed his teacher Biermer to Zurich, where Theodor Billroth was director of the hospital and influenced Kocher significantly. Kocher then proceeded to start a journey through Europe to meet several of the most famous surgeons of the time.[5] It is not clear how Kocher financed his trip but according to Bonjour (1981) he received money from an unknown female Suisse romande philanthropist who also supported his friend Marc Dufour and was probably a member of the Moravian Church.[5] In October 1865, he traveled to Berlin, passing through Leipzig and visiting an old friend from high school, Hans Blum. In Berlin, he studied under Bernhard von Langenbeck and applied for an assistant position with Langenbeck and Rudolf Virchow. Since there was no position available, in April 1867 Kocher moved on to London where he first met Jonathan Hutchinson and then worked for Henry Thompson and John Erichsen. Furthermore, he was interested in the work of Isaac Baker Brown and Thomas Spencer Wells, who also invited Kocher to go to the opera with his family. In July 1867, he traveled on to Paris to meet Auguste Nélaton, Auguste Verneuil and Louis Pasteur. During his travels, he did not only learn novel techniques but also got to know leading surgeons in person and learned to speak English fluently which allowed him later on to follow the scientific progress in the English speaking world with ease.

Once returned to Bern, Kocher prepared for his habilitation and on 12 October 1867, he wrote a petition to the ministry of education to award him the venia docendi (Latin: to instruct) which was granted to him. He became assistant to Georg Lücke who left Bern in 1872 to become professor in Strasbourg. Kocher was hoping to get his position, but at the time it was customary to appoint German professors to positions at Swiss universities. Accordingly, the faculty suggested Franz König before Kocher to follow Lücke. However, the students and assistants as well as many doctors preferred Kocher and started a petition to the Bernese government to choose Kocher. Also the press was in favor of Kocher and several famous foreign surgeons, such as Langenbeck from Berlin and Billroth from Vienna, wrote letters in support of Kocher. Under this public pressure, the Bernese government (Regierungsrat) chose Kocher as the successor of Lücke as Ordinary Professor of Surgery and Director of the University Surgical Clinic at the Inselspital on 16 March 1872, despite a different proposal by the faculty. Personal life

In 1869, he married Marie Witschi-Courant (1841 - 1921)[7][8] or (1850[5] - 1925). She was the daughter of Johannes Witschi who was a merchant[2] and she had three sons together with Kocher. The Kochers first lived at the Marktgasse in Bern and moved in 1875 to a bigger house in the Villette. The house became a place for friends, colleagues and guests to gather and many patients from Kocher's clinic were invited to dine at the Villette.

Like his mother, Kocher was a deeply religious man and also part of the Moravian Church. This was an uncommon trait that not many colleagues and co-workers shared and until his death, Kocher attributed all his successes and failures to God. He thought that the rise of materialism (especially in science) was a great evil, and he attributed the outbreak of the First World War.

Kocher was involved in the education of his three sons and played tennis with them and went horseback riding with them. The eldest son Albert (1872-1941) would follow him to the surgical clinic in Bern and become Assistant Professor of Surgery.

On the evening of 23 July 1917, he was called into the Inselspital for an emergency. Kocher executed the surgery but afterwards felt unwell and went to bed, working on scientific notes. He then fell unconscious and died on 27 July 1917.

Career

The call for an ordinary professorship at the University of Bern at the age of 30 was the first big career step for Theodor Kocher. In the 45 years he served as professor at the university, he oversaw the re-building of the famous Bernese Inselspital, published 249 scholarly articles and books, trained numerous medical doctors and treated thousands of patients. He made major contributions to the fields of applied surgery, neurosurgery and, especially, thyroid surgery and endocrinology. For his work he received, among other honors, the 1909 Nobel Prize in Physiology or Medicine. According to Asher, the field of surgery has transformed radically during the time of Theodore Kocher and later generations will build on the foundations created by Kocher – if a future historian wanted to describe the state of surgery at the beginning of the 20th century, he only need mention Kocher's Text-Book of Operative Surgery.

Three main factors contributed to Kocher's success as a surgeon, according to Bonjour (1981). The first factor was his consequent implementation of antiseptic wound treatment which prevented infection and later death of the patients. The second factor, according to Erich Hintzsche, was his monitoring of the anesthesia where he used special masks and later used local anesthesia for goitre surgery which decreased or removed the dangers of anesthesia. As a third factor, Hintzsche mentions the minimal blood loss which Kocher achieved. Even the smallest source of blood during surgery was precisely controlled and inhibited by Kocher, initially because he thought that decomposing blood would constitute an infection risk for the patient.

25 АВГУСТА ДЕНЬ КОХЕРА

В этот день в 1841 году родился швейцарский хирург Эмиль Теодор Кохер

Вспомним основные открытия и достижения великого врача: - Кохеру принадлежит значительная роль в разработке и внедрении методов антисептики и асептики. Им подробно изучены различные пути бактериального заражения ран, введено понятие об «имплантационной инфекции». Предложен получивший широкое распространение способ стерилизации шелка; - тематика научных исследований Э.Кохера была крайне обширна. Особое место в них занимали вопросы обще хирургического характера, в частности, актуальные для 70 – 90-х годов XIX века проблемы раневой инфекции, ее профилактика, лечения ран, общие вопросы оперативной техники, наркоза и т.д.; - одним из ранних увлечений Кохера являлась травматология. Им был разработан общеизвестный способ вправления вывихов плеча. Также известны его операции резекции крупных суставов с «крючковидными» разрезами; - труд Кохера «Учение о хирургических операциях» стал настольной книгой и незаменимым советчиком для многих поколений хирургов; - одним из первых он доказал необходимость строгой индивидуализации при применении различных видов анестезии у больных; - Кохер обладал выдающимся даром хирургического творчества. С его именем связан целый ряд оперативных способов и приемов. В хирургической практике нашли применение инструменты, предложенные Кохером: кровоостанавливающие зажимы, зобные зонды, ложки и щипцы, желудочные жомы и пр.; - во время Франко-прусской войны 1870 г. Кохер начал изучать механизмы образования мелкокалиберных огнестрельных ранений, результатом чего стало создание гидравлической теории образования огнестрельных ран; - Кохер был одним из основоположников абдоминальной хирургии. С его именем связан целый ряд практических предложений, относящихся к этой области: способ резекции желудка, мобилизация двенадцатиперстной кишки, рациональный разрез брюшной стенки при операциях на печени и пр.; - серьезным вкладом в науку стали работы Кохера, относящиеся к повреждениям головного мозга, заболеваниям мужских половых органов, способы декомпрессивной трепанации черепа, резекции языка, ампутации прямой кишки, грыжесечений по Кохеру и пр.; - всемирное признание Кохеру принесли его ценные работы, посвященные заболеваниям щитовидной железы. За выдающиеся труды в области физиологии, патологии и хирургии щитовидной железы в 1910 году Э.Кохеру была присвоена Нобелевская премия по физиологии и медицине; - Кохера называют одним из основателей пластической хирургии в Европе; - имя Кохера носит один из симптомов острого аппендицита. Кохер всегда ратовал за возможно раннюю операцию при этом заболевании; - всю жизнь (91 семестр) Кохер проработал в скромных условиях Бернской хирургической клиники, несмотря на предложение ведущих медицинских центров мира. За 45 с лишним лет своей профессиональной деятельности Кохер у себя в клинике принял более 10 тысяч ученых из разных стран; - Кохер обладал выдающимся педагогическим даром. Лекции и клинические разборы его отличались исключительной ясностью и богатством содержания. В основе преподавания хирургии была не операция, а обучение тщательному исследованию больного путем сосредоточения внимания либо на патологических изменениях, либо на разъяснении того или иного клинического явления; - каждый случай из своей клинической практики Кохер подвергал вдумчивому изучению. Все выводы теоретического характера он неизменно проверял практикой; - в клинике Кохера проходила лечение Н.К.Крупская (ей была проведена операция по поводу базедовой болезни); - научное наследие Кохера включает в себя более 150 статей, монографий, руководств; - Кохер был великим тружеником, все его интересы сосредотачивались на медицине и особенно на хирургии. Его отличали скромность и благородство. До последних дней он сохранил энергию и ясность мысли, способность к труду. Еще за 3 дня до смерти, на 76-м году жизни, он сделал трудную лапаротомию – последнюю в своей жизни хирургическую операцию.

"Хроники. Истории про врачей, пациентов, фармацию и медицинскую науку". Клуб любителей истории медицины. http://hroniki.org