Emil Theodor Kocher

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Emil Theodor Kocher
Emil Theodor Kocher.jpg
Emil Theodor Kocher
Born (1841-08-25)25 August 1841
Bern, Switzerland
Died 27 July 1917(1917-07-27) (aged 75)
Known for Developer of Thyroid surgery
Medical career
Profession Surgeon
Institutions University of Bern
Notable prizes Nobel Prize in Physiology or Medicine (1909)


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.[3]

Kocher's forceps, a surgical instrument with serrated blades and interlocking teeth at the tips used to control bleeding in surgery, is named after him.[4]

Early Life and Personal life[edit]


Kocher's father was Jakob Alexander Kocher (1814-1893),[5] the sixth of seven children to Samuel Kocher (1771-1842), a carpenter, and Barbara Sutter (1772-1849).[6] 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).[6] 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.[6] In 1858 he left the states service and managed several engineering projects around Bern.[6]

Theodor Kocher's mother was Maria Kocher (née Wermuth)[2] living from 1820 to 1900.[6] 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.[6] 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.[6] 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.[7]


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.[6] 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[8][9] (March 1865)[6] or 1866[2] [note 1] with his dissertation about Behandlung der croupösen Pneumonie mit Veratrum-Präparaten under professor Biermer with the predicate summa cum laude unamimiter.[6]

In spring 1865, Kocher followed his teacher Biermer to Zurich where Theodor Billroth was director of the hospital influenced Kocher significantly.[8] Kocher then proceeded to start a journey through Europe to meet several of the most famous surgeons of the time.[6] 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.[6] 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.[6]


Personal life[edit]

In 1869, he married Marie Witschi-Courant[10][note 3] (1841 - 1921)[8][9] or (1850[6] - 1925).[note 4] 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.[6]


Kocher was involved in the education of his three sons and played tennis with them and went horseback riding with them.[6] The eldest son Albert (1872-1941)[9] would follow him to the surgical clinic in Bern and become Assistant Professor of Surgery.[11]





Early career[edit]

Kocher first attained international recognition with his method to reset a dislocated shoulder published in 1870.[2][12] The new procedure was much less painful and safer than the traditionally used procedure and could be performed by a single physician. Kocher developed the procedure through his knowledge of anatomy.[6] In the same period, Kocher also studied the phenomena of bullet wounds and how they can cause bone fractures. From these studies resulted one public lecture in 1874 Die Verbesserung der Geschosse vom Standpunkt der Humanitaet and an 1875 manuscript Ueber die Sprengwirkung der modernen Kriegsgewehrgeschosse. He showed that small caliber bullets were less harmful and recommended to use bullets with slower speed.[6]

Relocation of Inselspital and call to Prague[edit]



Aseptic Surgery[edit]

It is unclear whether Kocher directly knew Joseph Lister, who pioneered the antiseptic (using chemical means to kill bacteria) method, but Kocher was in correspondence with him.[6] Kocher had recognized the importance of aseptic techniques early on, introducing them to his peers at a time when this was considered revolutionary. In a hospital report from 1868, he attributed the lower mortality directly to the "antiseptic Lister's wound bandaging method" and he could later as director of the clinic order strict adherence to the antiseptic method.[6] Bonjour (1981) describes how his assistants were worried about wound infection for fear of having to explain their failure to Kocher himself.[6] Kocher made it a matter of principle to investigate the cause of every wound infection and remove every potential source of infection, he also banned visitors from his surgeries for this reason.[6]

He published multiple works on aseptic treatment and surgery.[8]

Contributions to Neurosurgery[edit]



The American surgeon Harvey Cushing spent several month in the lab of Kocher in 1900, performing cerebral surgery and first encountering the Cushing reflex which describes the relationship between blood pressure and intracranial pressure. Kocher later also found that decompressive craniectomy was an effective method to lower ICP.[8]


Contributions to Thyroid surgery[edit]

Thyroid surgery, which was mostly performed as treatment of goitre with a complete thyroidectomy when possible, was considered a risky procedure when Kocher started his work. Some estimates put the mortality of thyroidectomy as high as 75% in 1872.[13] Indeed, the operation was believed to be one of the most dangerous operations and in France it was prohibited by the Academy of Medicine at the time.[13] Through application of modern surgical methods, such as antiseptic wound treatment and minimizing blood loss, and the famous slow and precise style of Kocher, he managed to reduce the mortality of this operation from an already low 13% (compared to contemporary standards) to less than 0.5% by 1912.[8] By then, Kocher had performed over 5000 thyroid excisions.[8] The success of Kocher's methods, especially when compared to operations performed by Theodor Billroth who was also performing thyroidectomies at that time, was described by William Stewart Halsted as follows:


William Stewart HalstedHalstead WS. The operative story of goitre. Johns Hopkins Hosp Rep 1919;19:71-257. -- Quoted in Morris et al. [14]

Kocher and others later discovered that the complete removal of the thyroid could lead to cretinism (termed cachexia strumipriva by Kocher) caused by a deficiency of thyroid hormones. The phenomena was reported to Kocher first in 1874 by the general practitioner August Fetscherin[15] and later in 1882 by Jacques-Louis Reverdin together with his assistant Auguste Reverdin (1848-1908).[2] Reverdin met Kocher on 7 September in Geneva at the international hygienic congress (internationaler Hygienekongress) and expressed his concerns about complete removal of the thyroid to Kocher.[16] Kocher then tried to contact 77 of his 102 former patients and found signs of a physical and mental decay in those cases where he had removed the thyroid gland completely.[17] Ironically, it was his precise surgery that allowed Kocher to remove the thyroid gland almost completely and led to the severe side effects of cretinism.

Kocher came to the conclusion that a complete removal of the thyroid (as it was common to perform at the time because the function of the thyroid was not yet clear) was not advisable, a finding that he made public on 4 April 1883 in a lecture to the German Society of Surgery and also published in 1883 under the title Ueber Kropfexstirpation und ihre Folgen.[18] Reverdin had already made his findings public on 13 September 1882[16] and published further articles on this topic in 1883; yet still Kocher never acknowledged Reverdin's priority in this discovery.[2][12] At the time, the reactions to Kocher's lecture were mixed, some people asserted that goitre and cretinism were different stages of same disease and that cretinism would have occurred independently of the removal of the thyroid in the cases which Kocher described.[16] In the long run however, these observations contributed to a more complete understanding of thyroid function and were one of the early hints of a connection between the thyroid and congenital cretinism. These findings finally enabled thyroid hormone replacement therapies for a variety of thyroid related diseases.[14]

Further contributions to science[edit]


A number of instruments (for example the craniometer[19]) and surgical techniques (for example, the Kocher manoeuvre, and kocher incision) are named after him, as well as the Kocher-Debre-Semelaigne syndrome. The Kocher manoeuvre is still a standard practice in orthopaedics.[3] Kocher is also credited for the invention of the Kocher's Surgical Clamp in 1882, which he used to prevent blood loss during surgery.[12]

One of his main works, Chirurgische Operationslehre (Text-Book of Operative Surgery [20]), was published through six editions and translated into many languages.[8]

During his life, Kocher published 249 articles and books and supervised more than 130 doctoral candidates.[3] He was rector of the university in 1878 and 1903.[6] He was president of the Bernese and the Swiss physicians association and co-founded the Swiss society for surgery in 1913 and became its first president.[6]

In 1904 / 1905 he built a private clinic called "Ulmenhof" which had space for 25 patients. Here Kocher catered to the wealthier patients, which in many cases were international.[6] He also treated the wife of Lenin, Nadezhda Krupskaya and operated on her in Bern (in 1913[21]).[12]


Bust of Theodor Kocher (created by Karl Hänny)

Kocher was also a famous and loved teacher. During nearly 100 semesters he taught his knowledge to about 10 000 students of the University of Bern. He was able to inspire students and taught them to think clearly and logically. Specifically, Kocher also taught a generation of Jewish-Russian students who could not study in Russia.[6] This association with Russia has also led the Russian geographic society to name a volcano after him (in the area of Ujun-Choldongi).[6] Among his many local and international students were Carl Arend (Bern), Oscar Bernhard (St. Moritz), Andrea Crotti (Ohio), Gustave Dardel (Bern), Carl Garrè (Bonn), Gottlieb and Max Feurer (St. Gallen), Anton Fonio (Langnau), Walter Gröbly (Arbon), Carl Kaufmann (Zurich), Albert Kocher (Bern), Joseph Kopp (Luzern), Ernst Kummer (Geneva), Otto Lanz (Amsterdam), Edmond Lardy (Geneva) Jakob Lauper (Interlaken), Albert Lüthi (Thun), Hermann Matti (Bern), Charles Pettavel (Neuenburg), Paul Pfähler (Olten), Fritz de Quervain (La Chaux de Fonds / Basel / Bern), August Rickli (Langenthal), Ernst Rieben (Interlaken), August Rollier (Leysin), César Roux (Lausanne), Karl Schuler (Rorschach), Fritz Steinmann (Bern), Albert Vogel (Luzern), Hans Wildbolz (Bern) as well as the American neurosurgeon Harvey Cushing.[6] Other notable students of his include Hayazo Ito (1865 - 1929) and S. Berezowsky which also spread his techniques in their respective home-countries (Japan and Russia).[10][22]

Kocher's name is living on with the Theodor Kocher Institute, the Kochergasse and the Kocher Park in Bern.[8] In the Inselspital, there is a bust of Kocher, created by Karl Hänny in 1927.[23] In the Kocher Park there is another bust, created by Max Fueter. In the Manchuria, a volcano is named after Kocher.[12]

In 1950, the Swiss historian Edgar Bonjour (1989-1991) who was married to Dora Kocher[24] wrote a 136-page monograph on Kocher's life that was extended again in 1981.[6]


  • Nobel Prize in Physiology or Medicine (1909)
  • Hon FRCS (Fellow of the Royal College of Surgeons, 25 July 1900)[25]
  • President of the Bernese and Swiss physician societies[6]
  • President of the Swiss society for surgery[6]
  • President of the German society for surgery (1902)[6]
  • Honorary member of the German society for surgery (1902)[6]
  • Chairman of the first international surgery conference in Brussels 1905[6]
  • several honorary memberships and honorary doctorates[6]




  3. ^ Several alternative spellings to Marie Witschi-Courant exist, for example Maria Witschi (ref hls), Witchi (ref choong2009), Witchi-Cournant (ref tan2008), Maria Witschi but in letters "Marie" (ref http://katalog.burgerbib.ch/deskriptordetail.aspx?ID=137721
  4. ^ The Bernese Burgerbibliothek give 1850-1925 as her living years and also Bonjour 1981 writes (pg 86) that she was nineteen in 1869 but does not give a date of death


  1. ^ "Kocher, Emil Theodor (1841-1917) in the Burgerbib". Retrieved 6 December 2012. 
  3. ^ a b c d Gautschi, OP.; Hildebrandt, G.; Kocher, ET. (Jun 2009). "Emil Theodor Kocher (25/8/1841-27/7/1917)--A Swiss (neuro-)surgeon and Nobel Prize winner.". Br J Neurosurg 23 (3): 234–6. doi:10.1080/02688690902777658. PMID 19533456. 
  4. ^ http://www.merriam-webster.com/medical/kocher%27s%20forceps
  5. ^ "Kocher, Jakob Alexander (1814-1893) in the Burgerbib". Retrieved 6 December 2012. 
  6. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at Bonjour, Edgar (1981) [1st. pub. in 1950 (http://d-nb.info/363374914)]. Theodor Kocher. Berner Heimatbücher (in German). 40/41 (2nd (2., stark erweiterte Auflage 1981) ed.). Bern: Verlag Paul Haupt. ISBN 3258030294. 
  7. ^ Bonjour, Edgar (1950 / 1951). "Theodor Kocher". Schweizer Monatshefte : Zeitschrift für Politik, Wirtschaft, Kultur (in German) 30. doi:10.5169/seals-159844. 
  8. ^ a b c d e f g h i Choong, C.; Kaye, AH. (Dec 2009). "Emil theodor kocher (1841-1917).". J Clin Neurosci 16 (12): 1552–4. doi:10.1016/j.jocn.2009.08.002. PMID 19815415. 
  9. ^ a b c "http://www.nobelprize.org/nobel_prizes/medicine/laureates/1909/kocher-bio.html". Retrieved 6 December 2012. 
  10. ^ a b c d e Hildebrandt, G.; Surbeck, W.; Stienen, MN. (Jun 2012). "Emil Theodor Kocher: the first Swiss neurosurgeon.". Acta Neurochir (Wien) 154 (6): 1105–15; discussion 1115. doi:10.1007/s00701-012-1341-1. PMID 22492296. 
  11. ^ Tan, SY.; Shigaki, D. (Sep 2008). "Emil Theodor Kocher (1841-1917): thyroid surgeon and Nobel laureate.". Singapore Med J 49 (9): 662–3. PMID 18830536. 
  12. ^ a b c d e Gemsenjäger, Ernst (2011). "Milestones in European Thyroidology (MET) Theodor Kocher ( 1841-1917)". European Thyroid Association. 
  13. ^ a b Chiesa, F.; Kocher, ET. (Dec 2009). "The 100 years Anniversary of the Nobel Prize Award winner Emil Theodor Kocher, a brilliant far-sighted surgeon.". Acta Otorhinolaryngol Ital 29 (6): 289. PMC 2868208. PMID 20463831. 
  14. ^ a b Morris, J. B.; Schirmer, W. J. (1990). "The "right stuff": Five Nobel Prize-winning surgeons". Surgery 108 (1): 71–80. PMID 2193425.  edit
  15. ^ Hintzsche, E. (1970). "August Fetscherin (1849-1882), unjustly forgotten general practitioner". Schweizerische medizinische Wochenschrift 100 (17): 721–727. PMID 4924042.  edit
  16. ^ a b c Schlich, Thomas (1998). Die Erfindung der Organtransplantation: Erfolg und Scheitern des chirurgischen Organersatzes (1880-1930). Frankfurt/Main: Campus Verlag. pp. 35–91. Retrieved 5 December 2012. 
  17. ^ Ulrich, Tröhler. "Towards endocrinology: Theodor Kocher’s 1883 account of the unexpected effects of total ablation of the thyroid.". JLL Bulletin: Commentaries on the history of treatment evaluation www.jameslindlibrary.org. Retrieved 5 December 2012. 
  18. ^ Kocher, Theodor. "Ueber Kropfexstirpation und ihre Folgen". Archiv für Klinische Chirurgie 29: 254–337. 
  19. ^ Schültke, Elisabeth (May 2009). "Theodor Kocher's craniometer". Neurosurgery (United States) 64 (5): 1001–4; discussion 1004–5. doi:10.1227/01.NEU.0000344003.72056.7F. PMID 19404160. 
  20. ^ Text-Book of Operative Surgery
  22. ^ "Whonamedit - Hayazo Ito". Retrieved 6 December 2012. 
  23. ^ Berchtold Weber: Historisch-topographisches Lexikon der Stadt Bern-Kochergasse, 1976, retrieved 6. September 2010
  24. ^ Bonjour, Edgar in the HLS

Further reading[edit]

External links[edit]