Professor Emil Theodor Kocher Berne Switzerland Aug
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Professor Emil Theodor Kocher Berne Switzerland Aug. 25-1841 to July 27-1917 By W. O. Johnson, M.D. Obstetrics and Gynecology University of Louisville School of Medicine 1929 Most great men are known by their works and very little is told of their intimate personal life. Theodor Kocher was born August 25th, 1841 in Berne, Switzerland. An early account of his life is not recorded. He was raised in an atmosphere of culture. His appreciation of the best in life began early. From youth he demonstrated his studious tendencies, being a rather quiet, unassuming boy, but quite mischievous. His early training was in the grade schools, and he graduated from the university of Berne in 1865. Following his graduation he spent some time in study, in Berlin, London, Paris, and Vienna during which time he was a pupil of Langenbeck, Billroth and Luche. His associations with Billroth are said to have influenced him most of all. From 1886 to 1872, during his study in foreign clinics, he was Associate Professor of Surgery to professor Luche in Berne, and following Luche’s death in 1874, Kocher was unanimously elected to the chair of surgery at the age of 31. This chair he occupied with supreme distinction until his death in 1917. To be selected by his own people at such an age was indeed an outstanding honor. But why he remained in Berne has always been a question to some. The proverbial love to the Swiss for his country explain in part this apparent anamolu of why in such an age of intensive progression he positively refused to accept most flattering calls to extensive and remunerative fields of activity. For he found at home the most favorable and congenial surroundings to work. Nowhere in the world were so many natural advantages combined for the free promotion of this abnormal activity than in Switzerland geographically. Not restricted by politics and unhampered by social or financial prejudice, these and many other equally conductive conditions kept him in his most loved hometown. From his earliest medical training he was a born anatomist. His first contribution to surgery that attracted attention was as a student under Billroth. He worked out a method, now known by his name, for the reduction of dislocated shoulders. A case of old subcoracoid dislocation of the shoulder was brought into the clinic and every method to reduce the dislocation had been tried and failed. Billroth, turning to the spectators, asked if there was anyone who wished to give a suggestion. Kocher, having just perfected his method in such cases, stepped forward eagerly and asked to be allowed to try the procedure; the shoulder was replaced at once. When asked what method and process he used he said humbly, “the Kocher method.” He then described the usual position of the rent in the joint capsule, direction of movements of the head of humerus as it escaped from the joint, and the final position in which it must lie, and demonstrated why his method would succeed if duly position in which it must lie, and demonstrated why his method would succeed if duly carried out. By this (procedure) Kocher first attracted attention in surgery, and he kept before the profession from that time. Quite early in his career he realized the truths and the vast scope of listeners teaching, and was the first to pay strict attention to aseptic principles in open operations for carcinoma of the tongue. As a man Kocher was small in stature, thin, quiet, with a slow but keen appreciation of wit, an unceasing worker inhumanly patient and kind, with an indomitable will and unconquerable tenacity, and endowed with the typical old world courtesy. In his home he was always pleasant and affectionate, accepting only the truth, square and honest in all of his dealings, respected by all classes and beloved by his family. Because of his overwhelming generosity in the care of his patients he was prone to overtax his seemingly strength, and it was for this reason that Mrs. Kocher directed his social and many of his professional activities. Some of the stories of his so-called “henpecked” life are in striking contrast to the domination personality he presented in his profession. As a teacher he was diligent and earnest, tireless in his painstaking details. Working form 8:00 A.M to 10:00 he taught in the theater, where the cases were brought in, examined with great care and discussed at length. He was aided in teaching by some artistic ability. Never impatient with an honest if stupid effort on the part of the student, his voice grew high pitched and querulous when students would try to deceive him by asking thoughtless questions. It was said that at times, under such conditions, his small statue would fairly vibrate with frenzy in anger with the students for jesting over some point he had taken as serious. He was a man who was never precipitate in his diagnosis of a case; he knew the value of careful and repeated observations and insisted upon absolute certainty in each individual case. Rarely was there a case that he could not explain. He implanted into his students that sense of duty, which sacrifices all to the cause of the patient. He refused to distinguish between important and unimportant matters, for every detail held some importance for him and he never failed to impress this on his students. He did not train any great men in his own school, as did Billroth, but there are surgeons all over the earth who can say that in large or small part it is with pride they claim some humble share of his great inheritance. His pupils were attracted to his clinic, not so much by the brilliancy of his teaching, as by the amount of sound knowledge they knew was to be gained form him, and the excellent training in conservative and logical reasoning which they received. As a surgeon his life was one unceasing activity, he began teaching and operating at an early age, and throughout his career his freedom from prejudice for his own intellectual progeny was shown. His broad mindedness was shown in his early acceptance of Lister’s theory, use of aseptic surgery and in his use of Bassini’s operation when indicated, giving full credit for its merits, when Kocher’s hernia operation had already been accepted by many. He was consecrated to his profession as his very life, and his holidays were invariably devoted to theoretical work. There were few days in the summer or winter seasons of school when he did not visit the post mortem rooms to demonstrate an old operation or try out a new one. Throughout his whole long life his devotion to anatomy and his operative work on the cadaver were unceasing. As a result of this, every operation he did was a supreme exhibition of his perfect unceasing. As a result of this, every operation he did was a supreme exhibition of his perfect knowledge: combined with a flawless, aseptic conscience, technical efficiency, and unfaltering courage with sound unruffled judgment and the most exquisite gentleness that man could accomplish. He was unsurpassed in his observance of details in technique; no one seeing his operations could ever forget his tender care, exquisite gentle touch, and deft movements of every finger. Even the minutest detail was so arranged that was no hastening, no untidiness, no shedding of one drop of blood that could be spared, no loss of time. With infinite accuracy, care, and patience he obtained results as near absolute perfection as is possible in surgery, and by such work he was able to obtain apparently impossible results in his work. There were surgeons on the continent or abroad that could operate with much more speed but never was there one whose judgment was so sound in the performance of a daring operation where the risk of life arose. The so-called “Kocher speed” was uniform whether he performed the simplest or the most complex operation, and there is hardly a branch of modern surgery in which he has not left valuable and permanent impressions. Professor Kocher remained active until the very last, at the age of 76, shortly before he died, he lectured and operated with youthful vigor, and those who knew him had to admit that he displayed the same abounding energy at the close of his career as he did when he started his work in the Swiss Capitol. Professor Kocher not only kept a pace with the progress of science and time, he was ahead. Monihan states that Kocher lived a long life of unceasing industry and covered a wider range of subjects than any loving surgeon. His work in almost any one department of surgery alone would have made him a reputation as a surgeon of great gifts. In his resourcefulness he constantly devised methods, some entirely new, others wise, sound true modifications of old methods. His literary work was amazing both I quantity and in high value. He published numerous works on bones, stomach, gall bladder, hernia, cranial nerves, osteomyolitis and goiter, and as his chief distinction rests in his development of operating methods for thyroid disorders. I whish to speak of his extraordinary work in that branch of surgery. We find from 1866 to 1872, Theodor Kocher was assistant to professor Luche in Berne. During that time Luche performed ten goiter operations; of these patients, nine died. Two years after having been elected Luche’s successor, Kocher, in 1874, published his first paper on the thyroid gland-on the pathology and treatment of goiter.