Dean Holland Echols, MD: The Sixth Founder

LIFE AND MEDICAL CAREER

Dean Holland Echols was born in Appleton, Wisconsin, on April 28, 1904 (1 p60). The son of a physician, Echols graduated from Brown University and the University of Michigan Medical School. After training in neurology and neurosurgery at Michigan, he joined the faculty and wrote the second paper ever published on the surgical repair of a ruptured spinal disc. Echols met Alton Ochsner at several national surgical meetings and applied for a position on the Tulane faculty. Ochsner replied that he did not have any money in the budget to pay him but suggested that Echols would be able to establish a busy practice in New Orleans since neurosurgery was almost unknown in the South. Dr. Echols came to New Orleans in 1937 and served without pay at Tulane University while he built his local reputation as a pioneer in neurosurgery. Dr. Echols was an innovator with revolutionary ideas in his field. In 1938, he became a founding member and first president of the Academy of Neurosurgery. He served as president of the American Association of Medical Clinics and the New Orleans Society of Neurology and Psychiatry. After a career at the Ochsner Clinic that spanned more that 30 years, he retired in 1974 and served as a consultant at the Veterans Administration Hospital and as a clinical professor at Tulane University. He died at the age of 87, on November 26, 1991. Any honor roll of the men and women who made the Ochsner institutions flourish would have Dean Holland Echols' name at the top.

PERSONAL CHARACTER

Dr. Echols was described as outspoken and “…a visionary who demanded action on his ideas” (1 p60). He was a gifted and a pioneer neurosurgeon with great confidence in his abilities. While visiting the Mayo Clinic, Dr. Echols met Merrill Hines who was studying colon and rectal surgery prior to establishing a department at Ochsner (1 p62). Hines mentioned to Echols that one of the latter's New Orleans patients had entered the Mayo Clinic to undergo spinal surgery. “I'll see about that,” responded Echols. He visited the man, wrote on his chart that the patient was leaving Mayo, arranged for his discharge, and admitted him to the Touro Infirmary for surgery, which Echols performed himself upon his return to New Orleans. Hines expected the chief neurosurgeon at Mayo to be upset. Instead the doctor laughed and said: “That's Dean Echols for you. You know how he is.”

Dr. Echols believed in the group practice and was crucial in the development of the Ochsner Clinic. As an example of his commitment to the institution, when the patient load dropped and the Clinic was having financial difficulties, Dr. Echols was one of the two or three staff members asked not to draw their salaries, and he lived for 2 or 3 months on credit (1 p62). But when he felt that the institutions were not fulfilling their commitment to the staff, he was outspoken and controversial. On May 9, 1951, the physicians held a meeting in the Clinic lobby where they received bad news about the financial state of the Clinic from medical director Hiram W. Kostmayer (1 p113). After he finished, Dr. Echols took the floor and said that the time had come for the staff to stop complaining and looking elsewhere for jobs. In addition, he said that they should petition the executive committee and the Foundation trustees for a 10% salary increase retroactive to May 1, for a further 10% increase in the total salary budget, and for a sweetening of the retirement plan. Dr. Echols suggested that the proposed higher salaries could be financed if the Foundation would waive building rentals and hospital bed credits for the time being. He recalled, “I was one of the promoters of the Foundation's educational, research, and hospital programs. But I no longer can stand idly by and let the Foundation kill the goose that is laying the golden egg” (1 p113). Blanc Monroe was very angered by a report of the meeting and a day later, Kostmayer called Dr. Echols in his office and told him that he was in danger of being fired (1 p63). “I don't remember taking it too seriously,” Echols remarked years later. Apparently, his position was misunderstood. He had talked about the need for higher pay, but he also warned against action that would destroy the Clinic. In any case, “There was never any talk of a strike,” he said. “Too many of the staff were determined to stay, come hell or high water” (1 p63).

Dr. Edward Connolly, former head of the Department of Neurosurgery, not only worked very closely with Dr. Echols but also achieved notoriety as a neurosurgeon under Dr. Echols' tutelage. Dr. Connolly recalled, “Dean was the mind behind the creation of the Foundation. He was very unique, bright, and incisive, but also very unpredictable. At times, he would write informal comments on the chart that represented efficient communication to his colleagues, but in this day and age would not be acceptable. He had a dry wit. …He loved to play mind games with the residents. Sometimes he would only talk to the senior resident asking him to tell something to the junior resident who was also present.”

According to Dr. Connolly, cardiovascular surgeon Dr. Michael DeBakey, a former staff surgeon at the Ochsner Clinic, once called Dean Echols “the smartest person I ever met.” “He was not politically climbing, did not have an ego that needed to be fed. I got along very well with him and we worked well together,” said Dr. Connolly. “He was very helpful to my career; one of the highlights of my career was that I held the presidency of the Academy that Dr. Echols founded.”

Dr. Echols and his wife Francis Foerster had three children: Barbara Echols Rackley, Cynthia Echols Stewart-Everets, and Dean F. Echols. Mrs. Francis Echols died at the age of 93, on November 13, 2002. Dean F. Echols is a physician and lives in Litchfield, Connecticut. Mrs. Cynthia Stewart-Everets lives in Boston, and Mrs. Barbara Rackley lives in Lafitte, Louisiana.

The author (HV) had the opportunity to speak with Mrs. Rackley, who graciously gave her time and recollections of her father. Mrs. Rackley recently retired from Tulane University, where she worked as the Student Program Coordinator for the Pediatric Department.

“He was very strict, especially during the teenage years, but was a loving father,” Mrs. Rackley recalled. “I always remember that he came home every day for supper to spend time with us. …My brother [Dean F. Echols] wanted to sit all day and watch television, and my father felt that was inappropriate and would not help in studying. So, one day when my father came home, he picked up the television, took it to the backyard, and threw a brick into it to solve the issue…. He had a great sense of humor and was described by many people who knew him as a gentleman. He was always dressed with coat and tie, no matter the occasion.” Mrs. Rackley remembered that when she used to visit her parents after her father's retirement, she often found Dr. Echols reading, always wearing a coat and tie.

When asked if Dr. Echols had a hard time in contemplating retirement, Mrs. Rackley replied, “No, it was a very smooth transition. He had time to read books that he could not read while he was active in the profession. He was an avid reader of history, classics, and novels…. He was also the self-appointed gardener of the house.” According to Dr. Connolly, Dr. Echols was robbed twice while gardening and started carrying two wallets. The one he had while gardening had only $50. He used to say, “My life is only worth $50 dollars.”

THE ALTON OCHSNER MEDICAL FOUNDATION AND GRADUATE MEDICAL EDUCATION

Dr. Echols' contributions to the creation and success of the Ochsner Clinic were many and varied. He added prestige to the group on his own account and was paramount in the development of neurosurgery at Ochsner Clinic and in the city of New Orleans. Perhaps his most important contribution was the idea of a Foundation and a commitment to medical education.

Even before he became a full-time staff member, Dr. Echols began to worry about the problems of keeping the clinic thriving (1 p60–62). From a pamphlet published by the United States Public Health Service, he learned that more than a half of the group practices that had been established in United States had disappeared. Dr. Echols discussed his concerns with Junius Underwood, the business manager of the Ochsner Clinic. Finally, Echols recalled, “I decided to visit the largest clinic of them all and try to learn the secret of its success.” Paying his own way, and without consulting any of the founders, he spent a week examining the functioning of the Mayo Clinic in Rochester, Minnesota. “I became convinced,” he recalled, “that if Ochsner Clinic was to be successful, it would have to become affiliated with a non-profit medical foundation.” He persuaded Underwood, and together they had a meeting, unbeknownst to the partners, with Blanc Monroe. For more than an hour, Monroe listened. Then he reminded his visitors that he was the attorney to the founders, that they expected him to look after their financial interests, and that he intended to do just that. Echols and Underwood heard no more about the matter until they learned the partners were contemplating a foundation.

When he was invited to work full-time on staff in the Clinic, Dr. Echols told Dr. Caldwell he wanted to be put in charge of Ochsner's program for training residents (1 p62). As soon as the foundation was organized, he became the director of education, charged with getting the teaching activities underway. Mrs. Rackley recalled, “The training of physicians and the organization were very important for my father. He was very thorough and gave his trainees a very hard time, but they all learned to be good doctors.” Suffice it to say that Dr. Echols' visionary idea of education and research separated the Clinic from other hospitals in the city and in the state of Louisiana, and imparted a lasting reputation to the Ochsner Clinic.