Nobel-Honored Surgeons
Nobel-Honored Surgeons
In 1909, Swiss-born Emil Theodore Kocher was the first surgeon to receive a Nobel Prize, which he was awarded for his work on the physiology, pathology, and surgery of the thyroid gland. After completing his medical training in Germany in 1865, he returned to his native Switzerland to practice surgery in Berne, where his clinic became one of the first to recognize the value of antiseptic practices. At the close of the 19th century, thyroid surgery had a high mortality, with death frequently attributed to excessive hemorrhage. However, in Kocher's hands, thyroid surgery became increasingly safer. Over the course of several thousand thyroidectomies performed by Kocher and members of his clinic, Kocher refined the surgical procedure and expanded knowledge of thyroid physiology. He noted that injury to the recurrent laryngeal nerve caused vocal changes and observed that thyroidectomy in childhood interfered with growth and mental development, an observation that led to the development of the partial thyroidectomy. Today, surgeons remember Kocher because his name is attached a widely used clamp and to a unique procedure used for mobilizing the duodenum.
In 1911, Allvar Gullstrand, the son of a Swedish physician, received the Nobel Prize for outstanding work in ophthalmology. His main contribution was the study of light refraction in the ocular system. His development of the slit lamp, which he used as a means of focal illumination, is now still widely used by ophthalmologists during eye examination. Gullstrand eventually became a member of the Nobel Physics Committee.
The next surgeon to win the Nobel Prize was Alexis Carrel, a French physician, who worked in the United States, first at the University of Chicago and then at the Rockefeller Institute. A technically skilled surgeon, he received his prize in 1912 for developing new methods for suturing small blood vessels -- a contribution that led to the eventual development of successful operations for organ transplantation and open-heart surgery. In 1935, Carrel in collaboration with the famous aviator Charles Lindberg developed a perfusion pump that oxygenated organs and kept them viable after removal from the body -- a contribution that further advanced the field of organ transplantation. Heralded as a national hero, French cities renamed streets in his honor, but within a decade his fame had become infamy. In his book Man the Unknown, Carrel strongly endorsed eugenics and the extermination of undesirables as a way to improve the human race. Because of his support of Nazi Germany his name was removed from street signs after World War II.
Robert Bárány, an Austrian, is one of the least known surgeons to win the Nobel Prize. He became intrigued with the functioning of the vestibular apparatus, and developed a test using caloric stimulation to determine the presence or absence of vestibular disease (Bárány's test). He was awarded the Nobel Prize in 1914 for his research on the human vestibular apparatus. News that he had received the prize reached him in a Russian prison-of-war camp. On his release in 1916, Bárány returned to Vienna, but became disgruntled by criticism from colleagues who claimed he had not adequately credited the research of earlier scientists. Bárány left Austria and relocated to Sweden where he continued his research studies.
Frederick Banting was the first of 2 Canadian surgeons to win the Nobel Prize. Originally, he was interested in becoming a minister, but he eventually graduated with a degree in medicine from the University of Toronto and received further training in orthopaedic surgery. Stimulated by an article describing pancreatic atrophy after pancreatic ductal ligation, he theorized that ductal ligation could be used to isolate insulin from the residual islet cells. Working with Charles Best, then a medical student in the physiology laboratory of John R. McCleod, Banting isolated insulin and demonstrated that insulin was highly effective in treating diabetes -- first in dogs and, soon after, in humans. Considerable controversy erupted in 1923 when the prize went only to Banting and McCleod without recognition of the work of their colleagues. Banting shared his prize with Charles Best, the medical student who performed many of the experiments, and McCleod shared his with James B. Collip, the young chemist who helped with the isolation of the active substance. Tragically, Banting died in a plane crash during World War II at the age of 49.
Alexander Fleming was the next surgeon to receive the Nobel Prize in 1945 for his discovery of the first antibiotic agent -- penicillin. Although he never practiced surgery, Fleming trained as a surgeon and passed all the examinations for the Royal College of Surgeons. Instead of working as a surgeon, however, he became a bacteriologist and developed an early interest in wound infections. Although brilliant, his laboratory was often disorderly. His prize-winning discovery was entirely accidental. Upon returning from vacation, Fleming astutely noted that on several discarded Petri dishes, bacterial culture was hindered by the growth of a mold, from which he eventually isolated penicillin. Ernst Chain and Howard Florey, who developed methods for obtaining large quantities of the organism, shared the award with Fleming.
The Nobel Prize awarded in 1949 for the development of a now-abandoned neurosurgical procedure -- prefrontal lobotomy -- is the most controversial of all the awards in medicine. Walter Hess, a Swiss ophthalmologist who had a special interest in brain function, and Egas Moniz, a Portuguese neurologist who developed the procedure, shared the award. At the time, there were no effective drugs for managing disturbed mental patients, and prefrontal lobotomy, although not always successful, seemed to offer a therapeutic option for intractable patients. In the United States, thousands of such procedures were performed before drug therapy became available. A famous but tragic lobotomy patient was President John Kennedy's sister, Rosemary, who became incapacitated after the procedure. Moniz also suffered a tragedy when he sustained a serious injury after being shot by one of his patients.
In 1929, Werner Forssmann was a surgical resident in a German hospital when he performed an experiment that led directly to his winning the 1956 Nobel Prize. Forssmann wondered whether there might be an alternative to direct cardiac injection of drugs, a common emergency treatment at the time. Without obtaining approval from his supervisors, Forssmann successfully passed a ureteral catheter from his own antecubital vein to his heart, and then confirmed the location with radiography. The immediate result of this daring experiment was predictable: Forssmann was fired from his training program. On learning about the event, physician contemporaries of Forssmann believed that catheterization of the heart was too dangerous to ever become a useful procedure. Discouraged by the reaction to his discovery, Forssmann discontinued his cardiac research to become a urologist. After World War II, 2 American cardiologists, Cournand and Richards, further investigated Forssmann's technique, proving it to be a safe and valuable procedure. (Forssmann was not the only Nobel Prize winner to experiment on himself. Barry Marshall, who was awarded the 2005 Nobel Prize in medicine for discovering the role played by Helicobacter pylori in gastrointestinal disease, also used self-experimentation as the basis of his research.)
In 1966, Charles Huggins became the second Canadian and the second urologist to win the Nobel Prize. He received the award for discovering that hormones could deter the spread of prostate cancer. After completing his surgical training, he specialized in urology at the University of Chicago. He had many research interests, but his most important research focused on the association between hormones and cancer. He found that prostate cancer frequently responded favorably to hormonal manipulation brought about by orchiectomy and estrogen therapy. Later, he noted that bilateral adrenalectomy had a similar beneficial effect on patients who had refractory prostate cancer. Huggins lived to be 96 years old and continued to perform cancer research until late in his life, turning his attention in later years to breast cancer.
Joseph Murray is the only native-born American surgeon to receive a Nobel Prize. He was awarded the prize in 1990 for developing the field of organ transplantation. With a background in plastic surgery, Murray studied the role of the immune system in tissue rejection and discovered that skin from identical twins could be successfully exchanged without evidence of tissue rejection. In 1954, a unique opportunity arose at the Peter Bent Brigham Hospital in Boston when a monozygotic male twin who had a healthy brother was hospitalized with renal failure. In addition to the technical problems associated with kidney transplantation, the proposed surgery was surrounded by enormous ethical issues -- was it justifiable to cause potential harm to a healthy person for the potential benefit of a sick relative? After approval by hospital committees, Murray performed the first successful kidney transplant, opening a new area of surgery. At that time, transplant procedures could only be performed between identical twins because drug therapy to allow transplantation between persons of differing genetic patterns would not become available for another decade.
Are there any common qualities shared by this select group of Nobel laureates? Not all of the candidates showed early signs of their latent ability. On 2 occasions, Alexis Carrel failed the qualifying examinations for his French university -- which is probably why he came to the United States to undertake his research. Certainly, all of the laureates had enormous curiosity, and all were willing to pursue untried, innovative approaches in the pursuit of solutions to important problems. It is tempting to conjecture that all would have agreed with fellow laureate Barry Marshall, who said, "The greatest obstacle to knowledge is not ignorance but the illusion of knowledge."
Surgeon Nobel Laureates
Emil Theodore Kocher
In 1909, Swiss-born Emil Theodore Kocher was the first surgeon to receive a Nobel Prize, which he was awarded for his work on the physiology, pathology, and surgery of the thyroid gland. After completing his medical training in Germany in 1865, he returned to his native Switzerland to practice surgery in Berne, where his clinic became one of the first to recognize the value of antiseptic practices. At the close of the 19th century, thyroid surgery had a high mortality, with death frequently attributed to excessive hemorrhage. However, in Kocher's hands, thyroid surgery became increasingly safer. Over the course of several thousand thyroidectomies performed by Kocher and members of his clinic, Kocher refined the surgical procedure and expanded knowledge of thyroid physiology. He noted that injury to the recurrent laryngeal nerve caused vocal changes and observed that thyroidectomy in childhood interfered with growth and mental development, an observation that led to the development of the partial thyroidectomy. Today, surgeons remember Kocher because his name is attached a widely used clamp and to a unique procedure used for mobilizing the duodenum.
Allvar Gullstrand
In 1911, Allvar Gullstrand, the son of a Swedish physician, received the Nobel Prize for outstanding work in ophthalmology. His main contribution was the study of light refraction in the ocular system. His development of the slit lamp, which he used as a means of focal illumination, is now still widely used by ophthalmologists during eye examination. Gullstrand eventually became a member of the Nobel Physics Committee.
Alexis Carrel
The next surgeon to win the Nobel Prize was Alexis Carrel, a French physician, who worked in the United States, first at the University of Chicago and then at the Rockefeller Institute. A technically skilled surgeon, he received his prize in 1912 for developing new methods for suturing small blood vessels -- a contribution that led to the eventual development of successful operations for organ transplantation and open-heart surgery. In 1935, Carrel in collaboration with the famous aviator Charles Lindberg developed a perfusion pump that oxygenated organs and kept them viable after removal from the body -- a contribution that further advanced the field of organ transplantation. Heralded as a national hero, French cities renamed streets in his honor, but within a decade his fame had become infamy. In his book Man the Unknown, Carrel strongly endorsed eugenics and the extermination of undesirables as a way to improve the human race. Because of his support of Nazi Germany his name was removed from street signs after World War II.
Robert Bárány
Robert Bárány, an Austrian, is one of the least known surgeons to win the Nobel Prize. He became intrigued with the functioning of the vestibular apparatus, and developed a test using caloric stimulation to determine the presence or absence of vestibular disease (Bárány's test). He was awarded the Nobel Prize in 1914 for his research on the human vestibular apparatus. News that he had received the prize reached him in a Russian prison-of-war camp. On his release in 1916, Bárány returned to Vienna, but became disgruntled by criticism from colleagues who claimed he had not adequately credited the research of earlier scientists. Bárány left Austria and relocated to Sweden where he continued his research studies.
Frederick Banting
Frederick Banting was the first of 2 Canadian surgeons to win the Nobel Prize. Originally, he was interested in becoming a minister, but he eventually graduated with a degree in medicine from the University of Toronto and received further training in orthopaedic surgery. Stimulated by an article describing pancreatic atrophy after pancreatic ductal ligation, he theorized that ductal ligation could be used to isolate insulin from the residual islet cells. Working with Charles Best, then a medical student in the physiology laboratory of John R. McCleod, Banting isolated insulin and demonstrated that insulin was highly effective in treating diabetes -- first in dogs and, soon after, in humans. Considerable controversy erupted in 1923 when the prize went only to Banting and McCleod without recognition of the work of their colleagues. Banting shared his prize with Charles Best, the medical student who performed many of the experiments, and McCleod shared his with James B. Collip, the young chemist who helped with the isolation of the active substance. Tragically, Banting died in a plane crash during World War II at the age of 49.
Alexander Fleming
Alexander Fleming was the next surgeon to receive the Nobel Prize in 1945 for his discovery of the first antibiotic agent -- penicillin. Although he never practiced surgery, Fleming trained as a surgeon and passed all the examinations for the Royal College of Surgeons. Instead of working as a surgeon, however, he became a bacteriologist and developed an early interest in wound infections. Although brilliant, his laboratory was often disorderly. His prize-winning discovery was entirely accidental. Upon returning from vacation, Fleming astutely noted that on several discarded Petri dishes, bacterial culture was hindered by the growth of a mold, from which he eventually isolated penicillin. Ernst Chain and Howard Florey, who developed methods for obtaining large quantities of the organism, shared the award with Fleming.
Walter Hess
The Nobel Prize awarded in 1949 for the development of a now-abandoned neurosurgical procedure -- prefrontal lobotomy -- is the most controversial of all the awards in medicine. Walter Hess, a Swiss ophthalmologist who had a special interest in brain function, and Egas Moniz, a Portuguese neurologist who developed the procedure, shared the award. At the time, there were no effective drugs for managing disturbed mental patients, and prefrontal lobotomy, although not always successful, seemed to offer a therapeutic option for intractable patients. In the United States, thousands of such procedures were performed before drug therapy became available. A famous but tragic lobotomy patient was President John Kennedy's sister, Rosemary, who became incapacitated after the procedure. Moniz also suffered a tragedy when he sustained a serious injury after being shot by one of his patients.
Werner Forssmann
In 1929, Werner Forssmann was a surgical resident in a German hospital when he performed an experiment that led directly to his winning the 1956 Nobel Prize. Forssmann wondered whether there might be an alternative to direct cardiac injection of drugs, a common emergency treatment at the time. Without obtaining approval from his supervisors, Forssmann successfully passed a ureteral catheter from his own antecubital vein to his heart, and then confirmed the location with radiography. The immediate result of this daring experiment was predictable: Forssmann was fired from his training program. On learning about the event, physician contemporaries of Forssmann believed that catheterization of the heart was too dangerous to ever become a useful procedure. Discouraged by the reaction to his discovery, Forssmann discontinued his cardiac research to become a urologist. After World War II, 2 American cardiologists, Cournand and Richards, further investigated Forssmann's technique, proving it to be a safe and valuable procedure. (Forssmann was not the only Nobel Prize winner to experiment on himself. Barry Marshall, who was awarded the 2005 Nobel Prize in medicine for discovering the role played by Helicobacter pylori in gastrointestinal disease, also used self-experimentation as the basis of his research.)
Charles Huggins
In 1966, Charles Huggins became the second Canadian and the second urologist to win the Nobel Prize. He received the award for discovering that hormones could deter the spread of prostate cancer. After completing his surgical training, he specialized in urology at the University of Chicago. He had many research interests, but his most important research focused on the association between hormones and cancer. He found that prostate cancer frequently responded favorably to hormonal manipulation brought about by orchiectomy and estrogen therapy. Later, he noted that bilateral adrenalectomy had a similar beneficial effect on patients who had refractory prostate cancer. Huggins lived to be 96 years old and continued to perform cancer research until late in his life, turning his attention in later years to breast cancer.
Joseph Murray
Joseph Murray is the only native-born American surgeon to receive a Nobel Prize. He was awarded the prize in 1990 for developing the field of organ transplantation. With a background in plastic surgery, Murray studied the role of the immune system in tissue rejection and discovered that skin from identical twins could be successfully exchanged without evidence of tissue rejection. In 1954, a unique opportunity arose at the Peter Bent Brigham Hospital in Boston when a monozygotic male twin who had a healthy brother was hospitalized with renal failure. In addition to the technical problems associated with kidney transplantation, the proposed surgery was surrounded by enormous ethical issues -- was it justifiable to cause potential harm to a healthy person for the potential benefit of a sick relative? After approval by hospital committees, Murray performed the first successful kidney transplant, opening a new area of surgery. At that time, transplant procedures could only be performed between identical twins because drug therapy to allow transplantation between persons of differing genetic patterns would not become available for another decade.
The Common Thread
Are there any common qualities shared by this select group of Nobel laureates? Not all of the candidates showed early signs of their latent ability. On 2 occasions, Alexis Carrel failed the qualifying examinations for his French university -- which is probably why he came to the United States to undertake his research. Certainly, all of the laureates had enormous curiosity, and all were willing to pursue untried, innovative approaches in the pursuit of solutions to important problems. It is tempting to conjecture that all would have agreed with fellow laureate Barry Marshall, who said, "The greatest obstacle to knowledge is not ignorance but the illusion of knowledge."
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