Fletcher H. McDowell 1923-2017.

Fletcher H. McDowell, MD, died at his home in New York City on April 23, 2017. He was 93 years old. Fletcher graduated from Dartmouth College and then from Cornell Medical School in 1947. He continued training in medicine there and at Stanford, returning to neurology residency with Harold Wolff at Cornell. He then joined the Army Medical Corps and was chief of neurology at army hospitals in Bad Kanstadt and Landstuhl, Germany, for 2 years. After discharge, he went to Queen’s Square for a year and returned to New York in the mid 50s. Wolff appointed him chief of the Cornell Neurological Service at Bellevue Hospital. There he became involved with studies of stroke diagnosis and prevention and also with new treatments for Parkinson’s disease. When the Bellevue service folded into one academic line, he returned to Cornell and became the director of the Burke Rehabilitation Hospital. This brief appreciation mentions some pillars in a life of achievement, but only partly describes the man. He was a founding editor of this journal, Stroke. With Clarke Milliken and Irving Wright in 1971 and a cast of neurological and neurosurgical luminaries from the Stroke Council of the American Heart Association, he particularly appreciated the need for a new outlet that would consolidate stroke manuscripts for a growing focused group of investigators. Thanks in large part to Milliken’s efforts, when Fletcher took over in 1978, the “child had passed infancy...” and in Stroke, under his direction, there were nearly 150 articles per year from investigators from all over the world. He organized over a dozen Princeton Conferences, with Milliken, for the purpose of presenting new information and research about stroke, developing consensus positions for diagnosis and treatment, and giving voice to the improved neuroimaging methods for determining cerebral blood flow and its relationship to cerebral metabolism especially during ischemia.1,2 Coupled with an interest in platelet aggregation inhibitors, his recognition of the possibility for improving cerebral flow and reversing ischemia was prescient given our current age of tissue plasminogen activator and more aggressive invasive clot-busting procedures. He actually came to study cerebrovascular disorders after making remarkable contributions to the first medical management of Parkinson’s disease. Fletcher and his group recognized the brilliance of George Cotzias’ observation that patients with Parkinson’s disease tolerated a slow titration of L-DOPA (L-3,4dihydroxyphenylalanine). This led him to instigate a clinical trial, the results of which would irrevocably alter the treatment, and more, alter the way we think about degenerative neurological conditions. These studies were followed by the recognition that motor response fluctuations were related to plasma L-DOPA concentrations, carbidopa increased the effectiveness of L-DOPA, sustained release L-DOPA preparations would enhance mobility for some, and nearly all patients with Parkinson’s disease would develop cognitive impairment. In these chapters of his life, he worked collaboratively and successfully with peers and with young investigators. Although it is not surprising that his peers enjoyed working with him, his relationship with young faculty is noteworthy. Marked by generosity of spirit, he had an uncanny ability to encourage and then share credit, and that fact is supported by simply looking at the author lists of his articles. Again and again, he supported and encouraged new investigators through lean times and replete times, to pursue an interest and develop the argument. As he approached the task of running the Burke Rehabilitation Hospital, then under the auspices of Cornell Medical School, the challenge was not only administrative but how to awaken an interest in clinicians in the active care of the chronically ill, especially those with neurological injury. His straightforward, Fletcher H. McDowell 1923–2017