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Kienbock disease

Osteochondrosis of the lunate bone
R Kienbock (1871-1953) Austrian radiologist who introduced the use of dosage in administering X-ray therapy. He graduated from the University of Vienna in 1895 and after spending a year in London and Paris became an assistant to von Schrotter and commenced using X-rays in 1897. He developed their use diagnostically and therapeutically, which eventually led to an independent department of radiology being established in 1904. In 1910 he fell off his horse and fractured his skull. He changed into a quiet and withdrawn man and concentrated mainly on diagnostic use of X-rays, publishing an 8 volume work on the diagnosis of disorders of bones and joints. However he suffered another attack of severe depression which lasted for many years.

Kocher's incision

Right upper quadrant abdominal incision used for cholecystectomy
E T Kocher (1841-1917) Swiss surgeon whose name is given to the Kocher Institute in Berne. He was born in Berne and graduated in medicine from the University there. He was a student of Langenbeck and Billroth. From 1866-72 he was assistant to Professor Lucke at Berne, where Lucke operated on 10 patients with goitre and 9 died. He succeeded Lucke as Professor of Surgery in Berne in 1872 and in 1874 published his first 13 goitre operations with only 2 deaths. He did much experimental work on the thyroid gland and was the first to excise the thyroid for goitre in 1878. He performed this operation over 2,000 times and had only a 4 % mortality, truly remarkable when the era in which he was undertaking the operation is considered. He described myxoedema following thyroidectomy, "Cachexia strumipriva" which occurred in 30 out of 100 thyroidectomies. He undertook much experimental work on animals and was interested in the physiology of the brain and the spinal cord. He evolved a hydrodynamic theory for the effect of gunshot wounds and attempted in 1912 to accelerate haemostasis in internal haemorrhage by injecting a sterile coagulating fluid which had been derived by Fonio from platelets. Above all he was extremely painstaking and careful and at all times a calm and imperturbable operator. He was a complete master of dissection and maintained total asepsis at all times. He wrote an important textbook on operative surgery and made contributions to almost all areas including such things as hernias, shoulder dislocation and abdominal operations for resection and anastomosis of bowel loops and for the fashioning of colostomies. His methods were somewhat similar to those of Lister and Hallstead in that he relied on absolute precision and care rather than speed and show, and this was vindicated by his low mortality figures. Probably three men, Lister, Hallstead and Kocher, did more to improve operative mortality than any other surgeons of their time and ended the days when surgeons were regarded as good only if they were quick, rapid and spectacular. He won the Nobel Prize for his work on the thyroid gland in 1909 and the Kocher Institute in Berne was established as a permanent memorial to him. He retired as Professor of Surgery in 1911.