Surgical History
Sir John Charnley
August 29, 1911 - August 5, 1982
"There is a tendency to imagine that serious research nowadays can only come out of a laboratory, and the contributions from the pure act of thinking on clinical facts ended with the great clinicians of the past. In the training of young surgeons, the attempt to foster the habit of making clinical observations and questioning accepted beliefs ought to start from the earliest moment."
The biomechanics of hip stability, though complex, can be fundamentally understood by envisioning the hip joint as a fulcrum with two lever arms. The femoral head acts as the fulcrum, while the opposing lever arms represent the torque generated by body weight and the tension exerted by the lower limb abductors—namely the gluteus medius and minimus. Given that the lever arm of the abductors is, on average, 2.5 times shorter than that of body weight, these muscles must generate forces 2.5 times greater than body weight to maintain pelvic balance during a one-legged stance. Failure in this mechanism can result in gait abnormalities such as Trendelenburg, Duchenne, or waddling gaits. Recognizing how easily this delicate balance can be disrupted by conditions like osteoarthritis, rheumatoid arthritis, or sub-capital trauma underscores the immense contributions of Dr. John Charnley and his development of total hip arthroplasty (THA).
John Charnley was born on August 29, 1911, in Bury, Lancashire. He was educated at Bury Grammar School, where his natural affinity for the sciences was recognized early, prompting encouragement to pursue medicine. Dr. Charnley entered the Victoria University of Manchester's medical school in 1929 and graduated with an MB ChB in 1935. Remarkably, at the young age of 25, he became a Fellow of the Royal College of Surgeons of England. After completing his general surgery residency at Salford Royal Hospital, King's College London, and Manchester Royal Infirmary, Dr. Charnley encountered orthopedics for the first time in 1939 at Manchester Royal Infirmary, where he accepted a position as a resident casualty officer. This experience was abruptly interrupted by the outbreak of World War II, which led him to serve in the Royal Army Medical Corps in various locations outside England. This detour, however, proved advantageous as it positioned Dr. Charnley to become an orthopedic officer in charge of a military orthopedic center in Cairo, Egypt. There, he managed an orthopedic workshop where his creativity and inventiveness flourished, earning him a reputation as a pioneering force in orthopedic surgery.
After his service in Cairo, Dr. Charnley returned to Manchester and was appointed a consultant orthopedic surgeon at Manchester Royal Infirmary. His growing interest in hip pathology led him to establish a hip center at Wrightington Hospital in Wigan, which became the cornerstone of his career and the birthplace of modern total hip arthroplasty.
Understanding the anatomy of the hip joint is crucial to appreciating Dr. Charnley's contribution to orthopedic surgery. The hip is a ball-and-socket joint that masterfully balances stability and mobility, allowing a wide range of movements, including flexion, extension, abduction, adduction, medial and lateral rotation, and circumduction. The joint's articular surfaces consist of the hemispherical head of the femur and the lunate surface of the acetabulum, with the acetabulum nearly encompassing the entire femoral head. The acetabular labrum, a fibrocartilaginous structure, enhances the joint's stability by embracing the femoral head. The joint is further stabilized by three major ligaments: iliofemoral, pubofemoral, and ischiofemoral, which tighten when the hip joint is extended, slightly abducted, and medially rotated to enhance hip stability.
Before Dr. Charnley's innovations, common hip replacement methods, such as the Smith-Peterson and Judet operations, failed to achieve a balance between mobility and stability. The Smith-Peterson technique involved placing a loose-fitting metal cup between the femoral head and acetabulum, hoping the interaction would induce the formation of new cartilage-like tissue. Unfortunately, excessive fibrocartilage formation led to loss of joint mobility. The Judet operation replaced the femoral head with a plastic prosthesis, but the high friction between the prosthesis and the damaged acetabulum caused the prosthesis to loosen, leading to instability and further complications.
Dr. Charnley's groundbreaking achievement was rooted in his innovative approach to reducing friction within the joint and securing the prosthesis to bone. He overcame frictional challenges primarily by using ultra-high molecular-weight polyethylene (UHMWPE) to line the acetabulum. UHMWPE's exceptional wear resistance, low friction, and high impact strength made it ideal for synthetic cartilage. To address prosthesis loosening, Dr. Charnley used acrylic cement to tightly secure the metal prosthesis to the cancellous bone, creating a stable and durable bond.
In 1962, Dr. Charnley performed the first successful total hip arthroplasty at Wrightington Hospital. Today, approximately 500,000 modern hip replacements are performed annually in the United States, with a low revision rate of 0.5 percent per year for the first 20 years.
Dr. Charnley received numerous accolades for his contributions, including the Lasker Foundation Clinical Medical Research Award in 1974 and a knighthood in 1977. His work revolutionized orthopedic surgery, impacting millions of lives worldwide. Sir John Charnley passed away on August 5, 1982, in Manchester, England, leaving behind a legacy of innovation and compassion in medicine.
Sources:
Charnley J. ANCHORAGE OF THE FEMORAL HEAD PROSTHESIS TO THE SHAFT OF THE FEMUR. The Journal of Bone and Joint Surgery British volume. 1960 Feb;42-B(1):28–30.
CHARNLEY J. ARTHROPLASTY OF THE HIP A New Operation. The Lancet [Internet]. 1961 May; 277(7187):1129–32.
Erens G, Crowley M. Total Hip Arthroplasty. 2024 Sep 5;UpToDate.
Gomez PF, Morcuende JA. A historical and economic perspective on Sir John Charnley, Chas F. Thackray Limited, and the early arthoplasty industry. PubMed. 2005 Jan 1;25:30–7.
Gray's Anatomy. Chapter 77. 41st ed. Philadelphia: Elsevier; p. 1352-1394.e2.
Gray's Surgical Anatomy. Chapter 80. 1st ed. Philadelphia: Elsevier; p. 594-598.e2.
Jackson J. Father of the modern hip replacement: Professor Sir John Charnley (1911–82). Journal of Medical Biography. 2011 Nov;19(4):151–6.
Sophia Fox AJ, Bedi A, Rodeo SA. The Basic Science of Articular Cartilage: Structure, Composition, and Function. Sports Health: A Multidisciplinary Approach. 2009 Nov;1(6):461–8.
Wroblewski BM. Professor Sir John Charnley (1911-1982). Rheumatology. 2002 Jul 1;41(7):824–5.
Dr. Percival Pott
January 6, 1714 = December 22, 1788
Dr. Percival Pott is perhaps most widely known for his contribution to public health and epidemiology. A pioneer in public health, epidemiology, medicine, and surgery, he lived and worked in London, United Kingdom from 1714 to 1788. Back then, medical school and residency training were not formalized avenues for aspiring surgeons. At that time, education followed an apprenticeship model. Dr. Pott trained under Edward Nourse, a surgeon at St. Bartholomew’s Hospital in London.
Dr.Pott was one of the first to make a connection between environmental exposures (e.g. chimney soot) and disease onset. Chimney sweeping was a common occupation in the 18th century. In his practice, he saw an increasing number of scrotal cancers in patients who were chimney sweepers. In 1775, he wrote extensively about the role that “soot” plays as an environmental risk factor for scrotal cancer. His advocacy and work led to the establishment of regulatory standards and awareness for occupational health and safety, which influenced many practices that are in place today. His work outlined that it is possible that long-term exposure to certain substances can lead to the development of disease.
As a surgeon, Dr. Pott was also influential in the field of orthopedic surgery. He provided groundbreaking work with identifying and classifying different fracture patterns as well as their treatment. During his time, there was little understanding of the importance of immobilization in fracture management. Dr. Pott discovered that stabilizing a broken bone will aid in the healing process, which is a standard practice of today. Additionally, he was adept at treating various spinal disorders such as spinal tuberculosis and spinal deformity. His contributions to spinal tuberculosis, also known as Pott’s disease, include the identifying the spread of tuberculosis to the spine, manifestations of the disease in the spinal cord, and that spinal deformity in the form of kyphosis is a notable result of the disease.
In summary, Dr. Pott showcased the importance of paying attention to how disease processes start and how the world around us can contribute to it. His observations will forever be pinnacles in preventive medicine, orthopedic surgery, and infectious disease. We can all only hope to contribute as greatly as he did to the health and wellness of society.
Sources:
https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2011.10487.x
R. Adams Cowley, M.D.
1917 -1991
Sixty minutes is all that is afforded to those who are critically injured. Sixty minutes bridging the divide between life and imminent death. R. Adams Cowley, M.D., a trained thoracic surgeon and pioneer of emergency medicine and trauma resuscitation coined this concept after years of observing this one hour afforded to those most vulnerable to the mortality of severe traumatic injury. This concept known as the “Golden Hour,” greatly influenced his efforts that culminated in the establishment of the precedents that drive current emergency medicine, trauma medicine, and cardiothoracic surgery practices to date.
Dr. Cowley was born in 1917 and graduated medical school in 1944 from the University of Maryland with further training at the University of Michigan in Ann Arbor for fellowship. Dr. Cowley later served in the U. S. Army in the late 1940s in Europe, where he received extensive surgical training. Known for many groundbreaking surgical advancements, including being the first to perform open-heart surgery, inventing the Cowley surgical clamp, and development of the prototype pacemaker used by Dwight D. Eisenhower, Dr. Cowley is most recognized and celebrated for his dedication to the foundation of emergency medicine and treatment of shock trauma. During his term in the Army, Dr. Cowley pioneered the concept of the “Golden Hour,” which stressed the importance of receiving treatment for trauma within sixty minutes to improve mortality in regards to the management of shock patients in 1957. The concept of the Golden Hour was controversial at Cowley’s time because standard of practice at the time for severe trauma patients was to transport to the nearest hospital via ambulance to die. To make the milestones he needed in improving mortality for trauma patients, Dr. Cowley established the first “Shock Trauma” Center at the University of Maryland Hospital in 1959. In its early years, success rates of the Shock Trauma Center were often low due to delays in physician referral of trauma patients, often past the Golden Hour and when irreparable damage was imminent. To combat this, Dr. Cowley advocated for a more timely and streamlined patient transport system by using military helicopters to bring patients directly to the Center in 1968. By 1969, Dr. Cowley had established the first injured civilian helicopter transport system with the support of the Maryland State Police Aviation Division in addition to the first statewide coordinated EMS system of care by executive order from the Governor of Maryland by 1973. The executive order of 1973 ensured that ambulances and emergency transport were properly equipped and staffed for traumatic emergencies.
Because of the radical changes in emergency care he advocated for, Dr. Cowley was relentless in his drive to enforce the changes he proposed. Dr. Cowley persistently testified before legislatures while fighting for funding for resources needed to establish the standardization of trauma care that continue the positive acceleration of lives saved from critical injuries for years to come. The field of emergency medicine is largely established due his efforts in trauma resuscitation education for nurses, physicians, students, and providers alike.
Dr. Cowley demanded the same competence and dedication from both himself and those who worked with him. He had the vision for those critically injured to survive beyond the grim circumstance of their time, and he relentlessly fought for that vision to become a reality. Loyal to both his patients and staff, he was remembered to refuse vacations for almost fifty years so that his staff could spend their holidays with their families without compromising the meticulous oversight he needed for his critically injured patients. On October 27, 1991, Dr. R. Adams Cowley, the “Father of Trauma Medicine,” passed away at home and was later buried in Arlington National Cemetery.
Sources:
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https://www.umms.org/ummc/health-services/shock-trauma/about/history
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Lambert, Bruce (November 1, 1991). "Dr. R. Adams Cowley, 74, Dies; Reshaped Emergency Medicine". The New York Times.
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Kerr, W. A.; Kerns, T. J.; Bissell, R. A. (July 1999). "Differences in mortality rates among trauma patients transported by helicopter and ambulance in Maryland". Prehospital and Disaster Medicine. 14 (3): 159–164. doi:10.1017/S1049023X00027527. ISSN 1049-023X. PMID 10724739.
Dr. Thomas Earl Starzl
March 11, 1926 - March 4, 2017
“What was inconceivable yesterday, and barely achievable today, often becomes routine tomorrow.”
Dr. Starzl was a transplant surgeon whose achievements continue to make an impact in the lives of the over 144,000 annual organ transplant recipients worldwide. Known largely as the "Father of Transplantation," Dr. Starzl lived a life driven by curiosity and opportunity. It was said that Dr. Starzl stimulated his research and clinical teams to superhuman effort purely through the novelty of his work. He multiplied the effectiveness of his hands with intellectual passion and audacious leadership.
Thomas E. Starzl was born on March 11, 1926 in Le Mars, Iowa, the second son of first generation Czechoslovakian and Irish immigrants, Roman Frederick Starzl and Anna Laura Starzl.Following his service in the U.S. Navy after high school, Dr. Starzl obtained a bachelor's degree in biology in 1947 from Westminster College. He then went to earn his medical degree and doctorate in neuroscience at Northwestern University, which were both awarded in 1952. In 1950, Dr. Starzl also earned a master's in anatomy from Northwestern. It has been stated that Dr. Starzl was not the average medical student. One of his classmates described their medical class as, "142 medical students and Tom Starzl." Midway through his medical degree, Dr. Starzl took a year off to work with Dr. Horace Magoun on the organization and role of lower brain components. It was around this time that Dr. Starzl discovered the extralemniscal pathway, an alternative brain pathway for transmission of sensory stimuli to the cerebral cortex. This feat goes to show Dr. Starzl's inquisitive nature and pursuit of excellence.
Following graduation from medical school, he attended surgical residencies at Johns Hopkins University in Baltimore (1952–1956), the University of Miami (1956–1958), and Northwestern University (1958–1959). During his time at Johns Hopkins, Dr. Starzl characterized the first model of complete heart block in dogs. This method was devised for an eventual understanding of how to reverse complications encountered during open heart surgery. His brilliance again was at display but in a completely different field than neuroscience. Dr. Starzl clearly was a physician-scientist who sought opportunities to problem-solve for the betterment of patient care.
During his time in surgical residency, Dr. Starzl developed a keen interest in metabolism, leading to his interest in liver transplantation. Despite the relatively straightforward nature of liver transplantation [which consists of removal of the native organ and replacement with the donor graft via three vascular anastomoses and one biliary anastomosis], this would prove to be an incredible venture given the liver's need for double blood supply, highly variable coagulable state in liver disease, and lack of adequate immunosuppression at the time. Dr. Starzl's excellent surgical skills allowed him to dissect the high-pressure venous collaterals resulting from portal hypertension in his first ever attempt at liver transplantation in a 3-year-old child with biliary atresia. In this monumental procedure, Dr. Starzl was able to connect the donor graft to portal inflow instead of avoiding anastomosis to the portal system by connecting the caval system to inflow and outflow of the liver. The nutrient-rich blood provided directly by the portal vein was important for proper functioning of the graft. However, the problem of coagulopathy rapidly became evident, when despite Dr. Starzl’s extreme care and surgical precision, his patient exsanguinated during the operation. Following this dreadful event, Dr. Starzl knew that considerable hemostasis would be needed if liver transplantation were to ever occur and collaborated with Dr. Von Kaulla, a leading expert in the coagulation pathway. Dr. Von Kaulla pioneered use of epsilon amino caproic acid and specific coagulation agents which allowed liver transplantation to be tolerable. The lessons learned during Dr. Starzl's first attempt at liver transplantation, though detrimentally mournful and unfortunate, proved to be a foundation for an achievement that would later bring hope to millions worldwide.
After dealing with the issue of coagulopathy, the next problem that arose was the need for immunosuppression. At the time, organ transplantation was highly experimental in nature, and many other physician-scientists were unsuccessful in their attempts. Without proper immunosuppression, the average post kidney transplant survival period was less than 70 days, which was consistent with Dr. Starzl’s attempts in kidney transplantation.After the first seven unsuccessful liver transplants, five of which were performed by Dr. Starzl in the early 1960's, it was deemed that liver transplantation was highly experimental in nature. The lack of any immunologic regulation made the benefits of transplantation futile. It also made many doubt the overall feasibility of transplantation.
It may have been fate, but Dr. Starzl caught wind of a British transplant surgeon and researcher, Dr. Roy Y. Calne, who was using azathioprine to delay rejection of kidney allografts in dogs. Dr. Starzl obtained a supply of the new drug and began testing its effect in dogs he performed liver and kidney transplantation procedures on. Azathioprine alone only delayed signs of rejection for days or weeks;however, if a regimen of high dose prednisone was added, acute rejection was prevented and long term survival could be achieved. These findings spurred similar exciting results in human kidney allografts performed by Dr. Starzl. He would later present his substantial findings at the momentous 1963 National Research Council, during a time when there was a growing impression that organ transplantation was borderline unethical, should be ceased, and a pitiful attempt of physicians trying to assume the position of God. His presentation generated so much commotion that afterwards the council was described as, "Letting a genie out of a bottle." Many researchers followed him to Denver, where he moved following his first appointment at Northwestern, to learn of the immunosuppression cocktail he used to prevent graft and host immunological reactions allowing for long term survival of kidney allograft recipients in his care.
While Dr. Starzl's achievement with kidney allografts was tremendous, he was determined on completing liver transplantation with long-term survival. Equipped with his new method of immunosuppression, Dr. Starzl performed the first liver transplant in 1967 with long-term survival on a 19-month-old girl named Julie Rodriguez with hepatoblastoma. She lived 400 days but unfortunately passed away due to metastatic recurrence of her tumor. This success proved the concept of immunosuppression was possible with liver transplantation. It laid the groundwork for the numerous future successful transplant surgeries Dr. Starzl would go on to perform. From this point, he would continually refine his strategy for immunosuppression using agents such as cyclosporine and eventually tacrolimus, which is currently the gold standard for immunosuppression in transplant patients. Additionally, Dr. Starzl would contribute evidence that there existed donor-specific tolerance in organ recipients that worked in tandem with graft acceptance to promote successful outcomes. Dr. Starzl would also continue his experimentation by transplanting other organs and completing multivisceral transplantation; for example, completing the world's first heart and liver transplant on Stormie Jones, a 6-year-old female with severe heart disease from homozygous familial hypercholesterolemia on February 14, 1984.
Dr. Starzl is regarded as a pioneer to a field that many critics blatantly considered impossible. The book “1000 Years, 1000 People: Ranking the Men and Women Who Shaped the Millennium,” placed Dr. Starzl 213th on its list of those whose contributions have significantly impacted history. He was awarded many notable accolades, such as being inducted into the prestigious National French Academy of Medicine in 1992. On February 13, 2006, he was presented with the National Medal of Science for biological sciences by President George W. Bush in a White House East Room ceremony for his pioneering work in transplantation.
Dr. Starzl retired from clinical appointments in 1991 and stayed at the University of Pittsburg, where he moved following his short tenure at Denver. He spent his time actively in search of methods to refine transplantation. It was said that Dr. Starzl was a hospitable and welcoming host to guest researchers. He loved intricate discussions of basic immunology and seamlessly avoided clinical nuances for the betterment of patient care. His generous teaching and pedagogy was an expression of the American academic tradition.
Dr. Thomas E. Starzl, the renowned transplant surgeon and researcher, died at the humble age of 91 on March 4th 2017 in Pittsburg, PA. His death brought great mourning to the medical community he worked with throughout his career. Dr. Starzl was survived by his wife of 36 years, Joy; a son, Timothy, and a grandchild, Ravi. He was preceded in death by a daughter, Rebecca, and a son, Thomas.
Sources:
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https://www.statista.com/statistics/398645/global-estimation-of-organ-transplantations/
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doi: 10.1073/pnas.1714008114
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doi: 10.5500/wjt.v12.i3.55
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Fuhrman and Zimmerman's Pediatric Critical Care, 97, Hepatic Transplantation, 1162-1169.e2
Sushruta
~600 BC
In this issue, we will examine the legacy of Sushruta, the father of Indian surgery from the Vedic period. Although Sushruta’s surgical teaching took place in 600 BC, many of his surgical texts still have lasting relevance in modern medicine. A pioneer of the ancient practice of surgery, Sushruta was also one of the first advocates for medical education by suggesting practicing with autopsies to familiarize oneself with the human body. Sushruta thought of surgery in its most noble sense- a complete subject that was not separate from traditional medicine, but rather an all-encompassing art and science that required thorough understanding and dedication to fully develop an acumen.
Sushruta’s contributions to surgery were outlined in the “Sushruta Samhita,” (Sushrita’s compendium) which were the annals of the basis of medicine, surgery, ethics, and theory at that time. This era of civilization was within the Vedic period (5000 BC), where the Vedas, or the foundation of Indian teaching, was transcribed in the Sanskrit language for all to learn from and follow if they so choose. Sushruta created a series of Vedas, including the Rigveda, Samaveda, Yajurveda, and Atharvaveda. In the series, he detailed disciplines spanning from complex facial plastic surgery, flap dissections, obstetrics, and even the ramifications of mental illness. Sushruta further detailed uses of intoxicants such as wine and henbane as anesthetic agents for surgery, revolutionary in his time. As a testament of Sushruta’s legacy in the surgical arts, rhinoplasty described in his texts are referred to as the “Indian flap” in contemporary plastic surgery. Amidst these discussions, he also outlined how to conduct a proper surgery, with the importance of maintenance of hygiene of the surgeon and surgical space, minimizing pain, maximizing positive outcomes, communication with the patient, and preparation through constant study.
Sushruta epitomized the basis of medicine by creating a strong framework for generations of healthcare workers to understand and live by. Eventually the loss of the original text prompted efforts by Buddhist scholar Vasabandhu (AD 360-350) to rewrite it, which allowed Sushruta’s traditions to transcend to different nations and languages, such as Arabic, English, German, and Latin. Well ahead of his time, Sushruta’s collective teaching can be regarded as a code of ethics that is very much respected even in our modern practices of medicine and surgery.
Dr. René Gerónimo Favaloro
July 12 1923 - July 29 2000
This article mentions sensitive content regarding suicide, which some may find unsettling. If you or someone you know is suicidal, please get help from your local ER or call the suicide prevention hotline in your country.
In this issue, we will examine the touching and tragic life of Dr. René Gerónimo Favaloro, the legendary cardiothoracic surgeon best known for his contribution for pioneering the coronary artery bypass surgery using the great saphenous vein. A man of great compassion, he pursued medicine and practiced general medicine in rural Argentina out of selflessness for his community before joining the Cleveland Clinic to pursue cardiothoracic surgery to improve surgical outcomes of his home region in Buenos Aires.
Dr. Favaloro was born in La Plata, Argentina. He attended the School of Medicine at the National University of La Plata in 1941 and finished residency at the Hospital Policlínico San Martín in 1949. He later worked as a small-town doctor in Jacinto Aráuz in the rural La Pampa Province from 1950 until 1962. Jacinto Aráuz was not an affluent region of Argentina, and many of the villagers lived in poverty without access to basic hygiene, an observation that had a lasting impact on how Favaloro would approach medicine until the very last day of his life. After his brother graduated from medical school and joined him in La Pampa, Favaloro and his brother worked tirelessly to improve the quality of life of the impoverished community by establishing an operating room and the first blood donation facility in the province with their own savings and limited resources.
Despite his humble beginnings in rural medicine, Dr. Favaloro developed his interest in cardiothoracic surgery from regular contact with his mentors in La Plata, Dr. Federico Christmann and Dr. José Mar'a Mainetti. Federico and Mainetti would later recommend the Cleveland Clinic as a possible route to train in the latest advancements in the field. Favaloro’s interest and dedication led him to a visit to Dr. Crile and Dr. Effler in Cleveland. Effler, the head of cardiac surgery at the time, would later accept him as a resident in 1963.
While at the Cleveland Clinic, Favaloro was mentored by Dr. Mason Sones and Dr. William Proudfit, who were both heavily involved in the radical search for a surgical solution for bypassing coronary obstructions. At the time, direct myocardial revascularization for localized proximal coronary obstructions was carried out by the pericardial or venous patch-graft technique. A major disadvantage of this technique was that the arteriosclerotic plaque was allowed to remain in place, which often progressed or resulted in a secondary thromboembolic occlusion. The technique produced satisfactory results on cases involving the right coronary artery, but not cases involving the left main trunk. By 1968, Favaloro and his team would later mitigate the daunting left main artery disease by implementing a single bypass to the proximal segment of the left anterior descending branch, which showed excellent postoperative perfusion.
Favaloro made the difficult decision to return to Argentina to fulfill his promise of bringing advanced surgical expertise back to his community in 1970. His departure was protested by his mentors and the staff at the Cleveland Clinic as the institution had considered him an indispensable part of the cardiac surgery department. Nonetheless, Favaloro was warmly welcomed back into Argentina, where he initially worked as the Chief of Cardiac Surgery at Clinica Güemes before establishing the Favaloro Foundation in 1975. The Favaloro Foundation was developed as Dr. Favaloro’s vision to bring the same spirit of excellence in medical care and research as the Cleveland Clinic. By 1999, more than 400 cardiologists and cardiovascular surgeons were trained at the Foundation and actively providing care all over Latin America.
In the earlier days of the Foundation, the economic climate of Argentina was favorable, so there was little to no concern on maintaining the immense budget required to keep the Foundation afloat. By the late 1990s, Argentina’s economic climate was no longer in good standing. Favaloro suffered loss after loss due to defaults in payments from other hospitals and the government, estimating around $18 million. At the end of his life at the age of 77, Favaloro had poured his soul into developing the Foundation, which he understandably was desperate to save amidst the financial obstacles. As a last plea for the support of his Foundation and the lifesaving advances it generously provided, Favaloro wrote a letter to the President of Argentina pleading for the debt that the government had owed his institution. A week later, on July 29, 2000, Dr. René Favaloro was found dead in his apartment by a self-inflicted gunshot wound to the chest.
The international medical community mourned for his death, a shock across both Latin America and the United States. The world in that moment mourned the loss of an exceptional man, not just a physician or surgeon. In the numerous memoirs of him, Dr. Favaloro was regarded as a compassionate and humble man who genuinely touched the hearts of everyone he encountered even outside of medicine and surgery. He was remembered fondly by his patients and community as a fearless champion against injustice and oppression. To his colleagues, they recall his somber grief after the death of his patients, how he spent hours scrutinizing and recalling details of his decisions that were suspected to contribute to their unfortunate outcome. He was a dreamer who was generous and kind, someone who loved the ones he took care of enough to break his own heart in order to fix theirs.
Today, the Favaloro Foundation lives on. After his death, a new board of directors saved the Foundation by restructuring the overall management and placing more emphasis on fundraising. The Favaloro Foundation today provides highly specialized services in cardiology, cardiovascular surgery, pulmonology, nephrology, hepatology, and immunogenetics with an emphasis on serving the indigenous and impoverished populations of Argentina, just as how Dr. Favaloro would have envisioned.
Sources:
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https://www.fundacionfavaloro.org/welcome-to-the-favaloro-foundation/
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Favaloro RG. Surgical treatment of acute myocardial infarction. Journal of the American College of Cardiology. 2000 Apr 1;35(5):18B-24B.
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Krauss, Clifford (August 7, 2000). "Argentina Searches Its Soul Over a Suicide". The New York Times. Retrieved 15 June 2009.
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Captur G. Memento for René Favaloro. Tex Heart Inst J. 2004;31(1):47-60. PMID: 15061628; PMCID: PMC387434. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC387434/
William Stewart Halsted, MD
September 23, 1852 – September 7, 1922
In this month’s issue, we will take a look at the turbulent, but brilliant life of the infamous Dr. William Stewart Halsted. Dr. Halsted gained much of his notoriety from his approach to medical education, radical at his time, and his personal struggles with addiction, However, his contributions as a surgeon cannot be ignored as they are heavily integrated into the current standard of practice in General Surgery. This was a man whose greatest strength and weakness was his academic curiosity of medicine, which led him to both acclaimed discoveries and his personal struggles with addiction.
One of Halsted’s contributions to medicine was the introduction of the hospital chart in 1874 after graduating from the Columbia University College of Physicians and Surgeons. Although mundane to us in modern medicine, it proved to be an instrumental tool in tracking a patient's recovery and overall health while in the hospital. From his time in New York in 1880 to 1885, Halsted performed many medical feats that were considered bold in his time. In 1881, Halsted performed the first successful emergency blood transfusion secondary to obstetric hemorrhage recorded in the United States. He also performed the first cholecystectomy in the United States on his mother in 1882 with her complete recovery. Outside of surgery, he pioneered the practice of antiseptic surgery at Bellevue Hospital and transformed the classical teaching of medical education into a more hands-on approach.
In 1884, Halsted’s natural curiosity of the medical arts led him to the report made by Dr. Karl Koller that described the anesthetic properties of cocaine. Halsted, his students, and his colleagues experimented with cocaine to demonstrate its property as a safe local anesthetic when injected or applied topically. Unfortunately, many members of the cohort ultimately succumbed to the addiction of cocaine after this incident, including Halsted himself. His battle with addiction became an unfortunate struggle that ultimately led to the end of his medical career in New York.
Dr. Halsted eventually admitted himself into the Butler Sanatorium to address his addiction. When he was discharged in 1886, he joined William Welch as one of the four founders of Johns Hopkins Hospital. While at Johns Hopkins, Halsted’s notoriety further increased with his establishment of the first formal surgical residency program for postgraduate medical training in 1889. In his system of an internship followed by a period as assistant resident and a final stage as house surgeon, Halsted trained many prominent figures of surgery including Harvey Williams Cushing and Walter Dandy, the founders of neurosurgery, and Hugh H. Young, the founder of urology as a specialty. Despite producing many talented surgeons, the system is not without critique, and some historians suggest that Halsted’s rigid system of hierarchy with streamlined roles for efficiency was perhaps a way for him to hide his physical and mental decline due to his struggles with addiction.
While at Johns Hopkins, Halsted’s most well-known contributions to the surgical arts include the introduction of rubber gloves as common practice for surgery and his approach for radical mastectomy for breast cancer, which significantly reduced the rates of recurrence by removing lymph nodes surrounding the tumor. Halsted made further advancements in biliary, thyroid, and abdominal aneurysm surgeries. Other advancements that Halsted was responsible for include introduction of the Halsted Mosquito hemostat and the Halsted (mattress) suturing technique.
In his later years with Johns Hopkins, many noted that Halsted evolved from the bold and daring physician to a cautious surgeon who is meticulous to a fault. Contrary to how he approached medicine while in New York, Halsted stressed the importance of preserving the most original organs in surgery. Some critics have speculated that Halsted used the guise of attention to detail and conservative surgical principles to hide his further declining fine motor capabilities due to his addiction. Whether that is truly the case, it is all mere speculation, and we may never know Halsted true intentions and the true extents of damage caused by his personal struggles. What is evident to this day is the legacy Dr. Halsted left behind, and how much of his work are still the foundations of various standards in medicine from residency training to suturing techniques.
Sources:
Wright Jr. JR, Schachar, NS. Necessity is the mother of invention: William Stewart Halsted’s addiction and its influence on the development of residency training in North America. Can J Surg. 2020;63(1):E13-E19. Published 2020 Jan 16. doi:10.1503/cjs.003319
Osborne, Michael P. “William Stewart Halsted: his life and contributions to surgery.” The Lancet. Oncology vol. 8,3 (2007): 256-65. doi:10.1016/S1470-2045(07)70076-1
Gerald, Ember (2011). "Genius on the Edge: The Bizarre Double Life of Dr. William Stewart halsted". Anesthesiology. 114 (6): 1496–1497. doi:10.1097/ALN.0b013e318216e9fa. PMC 2898614.
Halsted, WS (1893). "The radical cure of inguinal hernia in the male". Annals of Surgery. 17 (5): 542–56. PMC 1492972. PMID 17859917
Princess Vera Gedroits
April 19, 1870 (or 1876) - March 1932
For this issue, we will take a look at the life and achievements of Princess Vera Gedroits, a Russian physician and author. Her strength through political instability and her contribution to the field of surgery were pinnacle to modern trauma and abdominal surgeries today. As Russia’s first military surgeon, Dr. Gedroits was heavily decorated in both her civilian and military lives. She was the first female professor of surgery in Russia, the first female military surgeon, and the first woman to serve as a physician to the Russian Imperial Court. Lastly, perhaps her most contribution to medicine in general, Gedroits was also the first to instill laparotomies for traumatic abdominal injuries.
Dr. Gedroits was an enigma of sorts; despite the magnitude of her achievements, not much is officially known about her. Limited records regarding Gedroits were published in English, so even her birth year is under debate. What we do know about Gedroits is that she was a descendant of Lithuanian royalty, and her wealthy background allowed her to complete education partially at home before attending school in St. Petersburg. She was arrested for taking part in left-wing revolutionary activities when she was sixteen, so as a result, she finished her medical education in Switzerland. Gedroits returned to Russia and officially obtained her title as a doctor after passing her medical exams in 1901.
The first position held by Dr. Gedroits as a physician is the appointed surgeon at the Maltsov Cement Factory in western Russia. In addition to performing surgeries, Gedroits implemented the installment of physiotherapy equipment and an x-ray machine at the hospital, both were state of the art equipment in her time when x-rays were discovered in 1985, less than a decade earlier. She treated 103 patients in her first year with only 2 deaths. Workers of the cement factory undertook physically exhausting labor that involved regular heavy-lifting, contributing to the weakening of the abdominal muscles that gradually developed into hernias. Gedroits focused most of her attention on abdominal surgeries with hernia repair, an experience that will benefit her and the field of surgery tremendously in the years that follow.
A couple of years after her position at the cement factory, Gedroits volunteered as a military surgeon for the Red Cross at the outbreak of the Russo-Japanese War. The war suffered immense casualties at both sides and is often mentioned as a premonition to the casualties that will occur in the subsequent war, WWI. Few records in English exist about Gedroits’ activity during the war. According to an unpublished 1997 British journal article by Dr. John Bennett, on September 26, 1904, Gedroits set up a field hospital at Mukden, present-day Shenyang in China. Her field hospital was not stationery, however. The field hospital was in fact a train with an operating car and five patient cars. This meant that the mobile hospital would come dangerously into the front lines to retrieve wounded soldiers. Although medical personnel are officially neutral, the surgical trains in motion are often not recognized; so they are still subsequently targeted by gunfire, risking the lives of medical personnel and volunteers. In this environment, Dr. Gedroits dared to perform interventions for abdominal wounds that were deemed inoperable by many of her counterparts in Western Europe. Gedroits stressed that early intervention was crucial in reducing the mortality of the wounded soldiers, specifically surgical attention within 3 hours of the abdominal wound. Because of her extensive experience in abdominal surgeries during her position at the cement factory hospital, she performed laparotomies for penetrating abdominal wounds with a high success rate. Her interventions were subsequently implemented into medical guidelines internationally.
Dr. Gedroits returned to Russia after the war and returned to her post as the chief surgeon at the factory hospital in 1905. She compiled and published a 57-page report with illustrations of her work in the war to submit to the Society of Military Doctors. Medical historians have since recognized that had others in the field paid attention to her publications, casualties during WWI could have potentially been reduced as her findings were published 10 years before the start of the war. In 1909, she was appointed as the attending physician in the Russian Imperial Court. However, during the February Revolution in 1917, Gedroits could not openly support the Russian Provisional Government as an employee of the Tsar. To remain neutral while respecting her friendship with the Imperial family, she returned to the battlefront as a military surgeon during WWI. She was sent to the front lines and was wounded during the demobilization after the Bolshevik Revolution. She recuperated and settled in Kiev with her long-time partner, Countess Nirod, for the remainder of her days.
Gedroits’ final days are somewhat tragic, and perhaps the reason why the world does not remember her despite her important contributions to medicine. Gedroits became a faculty of surgery in 1920 when the Kiev Medical Institute organized a surgery department, and subsequently became the department head of surgery in 1929. However, in the following year, she was removed from her post and denied a pension during the Soviet purge (Union for the Freedom of Ukraine trial). Despite her destabilization, she continued to work as a surgeon at the Intercession Monastery’s hospital and devoted the next two years into writing. Gedroit died in March 1932 of uterine cancer. She left her personal papers to her neighbors, Irina Avdiyeva and Leonid Povolotsky. Among the papers left behind was a letter from her professor, the Swiss surgeon Cesar Roux, advising his bequeathment of the Department of Surgery at the University of Geneva to Gedroits. During the purges of 1937-1938, Avdiyeva and Povolotsky’s apartment was raided. Upon the discovery of Gedroits’ letters, the couple were accused of imperialism and Povolotsky subsequently forcibly disappeared by the government.
Sources:
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Bennett JD. Princess Vera Gedroits: military surgeon, poet, and author. BMJ. 1992;305(6868):1532-1534. doi:10.1136/bmj.305.6868.1532
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https://www.bbc.com/future/article/20190418-the-princess-who-transformed-war-medicine -
Віленський (Vilenskyi), Юрій (Yurii) (5 September 1996). "Незвичайне життя Віри Гедройц" [The extraordinary life of Vera Gedroits] (in Ukrainian). Kyiv, Ukraine: День.
Robert Milton Zollinger, MD
September 4, 1903 – June 12, 1992
For this issue, we will look at the life and legacy of Dr. Robert Milton Zollinger. His name may sound familiar to those of us who came across the topic of gastrinomas during our gauntlet of USMLE and COMLEX exams. Although Zollinger was a surgeon through and through, his work with gastrinomas had been foundational in the field of pharmaceutical engineering and internal medicine.
Zollinger was, in every sense, a true underdog in the world of medicine and surgery in his time. Unlike his contemporary colleagues of medicine in the 20th century, Zollinger did not graduate from an Ivy League institution. Zollinger is an alumnus of Ohio State University for both his B.A. (1925) and M.D. (1927). Upon graduating medical school, Zollinger trained at the prestigious Peter Bent Brigham Hospital in Boston under Dr. Harvey Cushing in 1928. Zollinger was known as a country boy from Columbus, a “cow town,” among his Ivy League peers. As a result, he had developed a strong drive to prove his competency and the quality of his education to ultimately earn their respect. His endeavors in his solo competition against the rest of the surgical field refined his fundamental knowledge into a firm foundation for his later work. While in Boston, Zollinger met Dr. Elliot C. Cutler. The two would later return to Peter Bent Brigham Hospital as faculty professors of surgery from 1932 to 1939. In their partnership, Zollinger and Cutler will go on to publish the first nine editions of the Atlas of Surgical Operations, a famous and respected reference today.
Zollinger returned to his alma mater, Ohio State University, as the chairman of the Department of Surgery in the late 1940s after his service with the U.S. Army during the Second World War. In 1955, Zollinger’s work with Dr. Edwin Ellison pioneered gastrinoma research, leading to the discovery of the Zollinger-Ellison Syndrome, a condition caused by neuroendocrine tumors that leads to excess production of gastric acid in the stomach. Today, Zollinger-Ellison Syndrome is treated medically with proton pump inhibitors and octreotide. For Zollinger and Ellison, gastrinomas were treated with total gastrectomy. Zollinger’s work with gastrinomas led to the discovery of the hormone gastrin and later influenced the development of proton pump inhibitors.
Despite Zollinger’s humble beginnings and the uphill battle at the start of his surgical career, Zollinger was a perfectionist who expected nothing less from both himself and his students. He was especially hard on his students over minor infractions or mistakes and was feared among those who trained under him. Perhaps the hardship and pressures he faced made him more critical and inpatient towards his students who may or may not have the same background as him. As much as he was feared by his students, Zollinger was equally loved by his patients for his kindness and compassion when interacting with his patients. Still, Zollinger has many facets of life that are beyond research and medicine. His roots in farming fueled his passion for growing award-winning gourds and roses. He remained in Ohio State University and remained active in the Department of Surgery as Professor and Chairman Emeritus up until his death in 1992 from pancreatic cancer.
Today, nearly every medical student will remember Dr. Zollinger’s name as his contributions are ingrained into modern medical education. Zollinger’s journey in medicine is reminiscent of many first generation medical or college students, perhaps an optimistic reminder of how one’s fate can be changed by persistence and excellent competency. Dr. Zollinger left behind a legacy that is hard to forget, especially within modern surgery and medicine.
Sources:
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Rodgers, Kristin (April 11, 2011). "Robert M. Zollinger, MD". Ohio State University. Retrieved January 10, 2023.
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"Zollinger, Robert Milton (1903 - 1992)". Plarr's Lives of the Fellows. October 13, 2015. Retrieved January 10, 2023
Harvey William Cushing, MD
April 8, 1869 – October 7, 1939 (aged 70 years old)
For this issue, we will take a look at Dr. Harvey Cushing’s contributions to the surgical arts and medicine. While his name may be familiar to most of us for his work towards Cushing’s disease and the Cushing reflex, Dr. Cushing was also the first official neurosurgeon. Because of his expertise and discoveries, neurosurgery was established as a surgical specialty within our medical system.
Dr. Cushing completed his general surgery residency at the Johns Hopkins Hospital in Baltimore under Dr. William Halsted. Afterwards, he pursued further training in neurology under Dr. Emil Theodor Kocher (for Dr. Kocher’s story, see Issue #2) and Dr. Charles Scott Sherrington. With his newly obtained expertise in neurology and his training in surgery, Cushing led the surgical cases of the central nervous system as the associate professor of surgery at Johns Hopkins Hospital. It was at his position in Johns Hopkins that Cushing was internationally recognized as the first specialist in neurosurgery, and thus the field of neurosurgery was born.
The recognition of Cushing was a direct result from his expertise of the pituitary gland and his careful procedures for safe removal of brain tumors. By 1931, Cushing had completed two thousand tumor excisions. In order for Cushing to establish the credibility of his specialty, he needed to prove the safety and efficacy of his methods. Cushing was one of the first to use diagnostic imaging, x-rays, to diagnose brain tumors and was able to improve survival of patients after tumor resection significantly. As a result, Cushing’s career was centered around his patients and their stories. Patients from far and wide were brought to him for his skill and accompanying compassion. During the development of his surgical legacy, he was also loved and respected by his patients and their families.
Cushing made many contributions to surgery, including developing surgical instruments commonly used even today. One of the most fundamental surgical instruments today is the Bovie electrocautery tool, commonly referred to as the “Bovie” for those of us who have scrubbed into the OR in our training. It was first developed by Dr. William T. Bovie, a physicist at Harvard, and first employed in neurosurgical cases with Dr. Cushing. Together with Bovie, Cushing was able to re-explore brain masses that were inoperable before because of the significant reduction in bleeding while operating with the Bovie electrocautery tool. Other surgical tools developed by Cushing include the Cushing forceps, used for grasping the tissues of the scalp during cranial surgeries, and the Cushing ventricular cannula, used for CSF drainage in the ventricles.
Even so, some of Cushing’s greatest contributions were towards the field of internal medicine, not just surgery. For example, Cushing was responsible for the inclusion of blood pressure as part of the vital signs during routine medical examination. After visiting his colleague Riva Rocci, an Italian internist and pathologist, Cushing improved the design of Rocci’s mercury sphygmomanometer for the use of non-invasive measurement of systolic blood pressure. Another notable medical discovery includes describing the condition bearing his name, Cushing’s disease, which he defined as an increase of ACTH secretion due to pituitary malfunction.
Dr. Cushing’s contributions greatly influenced modern surgery and medicine, and many of his practices have been adopted and standardized even to today. However, even outside of the well-deserved respect of his medical accomplishments, Dr. Cushing was a beloved doctor first and foremost, as recounted by many of his patients. He was also a memorable mentor to many influential names in medicine while in his academic post including Walter Dandy, Louise Eisenhardt, and Wilder Penfield.
Sources:
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"Harvey Cushing as a book collector, bibliophile, and archivist: the precedence for the genesis of the Brain Tumor Registry." Historical vignette. Wahl CJ, Tubbs RS, Spencer DD, Cohen-Gadol AA. J Neurosurg 2009 Nov, 111(5):1091-5.
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https://library.medicine.yale.edu/cushingcenter/harvey-cushing
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https://onlineexhibits.library.yale.edu/s/harvey-cushing/page/home
Olga Jonasson, MD
1934-2006
In this issue, we will take a look at the legacy of Dr. Olga Jonasson, a sincere patient advocate, a pioneer for women in surgery, and “the first” for a multitude of positions. We all remember the mentors who shaped us into who we are or how we see ourselves in medicine. A strong mentorship and role model are pivotal for the careers of many physicians, especially in the field of surgery. In an environment where advocacy is needed for not only patients, but upcoming and rising physicians, Dr. Jonasson was more than just an accomplished surgeon.
To start off the recognition of her decorated experience, Dr. Jonasson was the first woman to be appointed as the chief of surgery at a major hospital, the first woman to lead an academic department of surgery, the first female surgeon to serve as the Medical Director in a major department of the American College of Surgeons, the first to perform kidney transplant surgery in the state of Illinois, and the founding member of the National Tissue Typing and Histocompatibility Organization.
As a medical student at the University of Illinois College of Medicine, she was one of the first few women who sought to join the field of surgery during a time when surgery was especially unwelcoming for women physicians. She completed her residency at the University of Illinois and pursued a postgraduate fellowship at Walter Reed Institute of Research in Washington D.C., where she completed her research in immunochemistry under the mentorship of Dr. Elmer Becker. She then completed a second fellowship at Massachusetts General Hospital in transplantation immunobiology under Dr. Henry Winn and Dr. Paul Russell. From 1967 to 1987, Dr. Jonasson served as a faculty member of the surgical department at the University of Illinois where she set up a statewide histocompatibility-testing laboratory for donor -recipient matching, which marks her as a pioneer in the field of clinical transplantation and histocompatibility. She was named chief of surgery at Cook County Hospital in 1977 and became the chair and professor for surgery at Ohio State University in 1987.
Dr. Jonasson returned to Chicago in 1993 for her appointment at her senior position at the American College of Surgeons, where she contributed to a large number of educational programs and research in surgery. In her later career, she became a member of the editorial boards of Annals of Surgery and the Journal of the American College of Surgeons. She was also a reviewer for the Journal of the American Medical Association and the New England Journal of Medicine. Dr. Jonasson also held influential positions in many surgical societies and the board of directors of the American Board of Surgery in addition to the Accreditation Council for Graduate Medical Education.
In her career, Dr. Jonasson mentored many young physicians and residents, many of whom hold influential positions within the medical and surgical communities today. In many accounts of her, she was widely honored by her students and mentees for her immense support and influence for her trainees. She was an advocate for the surgeons training under her, especially young female residents at a time when the culture of surgery was unforgiving for women and their commitments to their families. In addition, Dr. Jonasson widely supported residents and young surgeons of all genders and backgrounds by using her influence in providing opportunities as speakers or guests at national conferences for her trainees. She recognized the need for encouragement and support within the new generation of surgeons to the establishment of influential leaders of the future of medicine.
In the memories of many who knew her, some of the best contributions of Dr. Jonasson were more than her titles and awards, although she was certainly not short of her well-deserving honors. She was recounted fondly by many leaders within the fields of surgery, and it was her support and encouragement that led to the development of many distinguished surgeons and subsequent advancement in surgery.
Sources:
https://www.youtube.com/watch?v=YVqEOHIC1Rg&ab_channel=AmericanCollegeofSurgeons
"Olga Jonasson, MD, FACS (1934-2006)". American College of Surgeons. Retrieved October 29, 2019.
Husser W, Neumayer L. Olga Jonasson, MD: Surgeon, Mentor, Teacher, Friend. Ann Surg. 2006;244(6):839-840. doi:10.1097/01.sla.0000248100.13289.c0
Bartholomew, A.; Ascher, N.; Starzl, T. (August 1, 2007). "TRIBUTE: Dr. Olga Jonasson Born in Peoria, Illinois, August 12, 1934 Died in Chicago, Illinois, August 30, 2006". American Journal of Transplantation. 7 (8): 1882–1883. doi:10.1111/j.1600-6143.2007.01872.x. ISSN 1600-6143. PMID 17578502.
Emil Theodor Kocher
1841-1917
In this month’s surgeon spotlight, we feature Dr. Emil Theodor Kocher (1841-1917), the first surgeon to be awarded the Nobel Prize in Physiology or Medicine in 1909. Dr. Kocher was awarded the Nobel Prize for his work in developing the foundations of thyroid surgery and physiology. In addition, Dr. Kocher was a pioneer in the fields of organ transplantation and endocrinology.
The field of surgery was not perceived as a prestigious field of medicine in Kocher’s time. Similar to John Keats’ time, surgery was considered a manual craft and had been considered as separate from the profession of medicine. Surgical skill was only sought after in emergent situations. It was a field associated with exposing oneself to horrors of war, pain and infection. And yet, the Nobel Prize was awarded to a surgeon for the first time in history.
Dr. Kocher developed a technique to safely resect a goiter, an unprecedented feat in surgery that warranted his Nobel Prize in 1909. Through long-term observations of his patients from his operations, he was able to observe the physiological functions of the thyroid by the effects of its absence. Kocher was the first surgeon to implant human thyroid tissue as an attempt to correct the loss of thyroid functions. In the early 1800s, thyroidectomy was one of the most dangerous surgical procedures of his time, with a mortality rate of 75%. It was so dangerous that some hospitals had it banned. Kocher performed 5,000 thyroidectomies and was able to reduce the mortality to 18%. And it was his intense investigation into thyroid anatomy and surgical technique which made him discover that the removal of the thyroid could lead to cretinism.
Kocher made other contributions to the field of medicine outside of his Nobel Prize. He was the first to complete the chart of human dermatomes, published in 1896. He also developed the “Kocher Maneuver,” the dissection of the lateral peritoneal attachment of the duodenum for exposing the retroperitoneal structures over the great vessels. With his achievements, he was recognized as the leader and pioneer of modern surgery. His approach to physiology led to the development of the field of endocrinology and organ transplantation. Rarely has the Nobel Prize been awarded to a surgeon, but his contributions to the field of surgery and medicine as a whole have had a tremendous impact on present day practice. To this day, many medical students, residents, and surgeons will have used the Kocher forceps, one of the most fundamental tools in surgery named after Dr. Kocher as a lasting reminder of his contributions.
Sources:
Tröhler U (2010). Emil Theodor Kocher (1841-1917). JLL Bulletin: Commentaries on the history of treatment evaluation (https://www.jameslindlibrary.org/articles/emil-theodor-kocher-1841-1917/)
Schlich T. Nobel Prizes for surgeons: In recognition of the surgical healing strategy. International Journal of Surgery. 2007 Apr 1;5(2):129-33.
https://doi.org/10.1016/j.ijsu.2006.04.012