Dean H. Echols, MD, and Homer D. Kirgis, MD, made a lasting impression on one neurosurgeon. For John Clifford, MD, they changed the course of his life and were responsible for his decision to pursue neurosurgery as a specialty. In recognition of their influence, Dr. Clifford recently gave $10,000 to the Neurosurgery Research and Education Foundation (NREF) in honor of these two “greats” in the field of neurosurgery.
Dr. Echols: Master of Clinical Diagnosis
Dr. Echols came to New Orleans from Ann Arbor, Mich., before World War II. At the University of Michigan he was a contemporary of Edward Kahn, MD, and Dr. Echols and Dr. Kahn both trained under Max Minor Peet, MD.
While at Michigan in 1934, Dr. Echols and Dr. Peet were the first to report on the pathology and clinical features of ruptured cervical discs, as well as surgery to repair them. Dr. Echols published a paper reporting two cases of rupture of the intervertebral disc; this may have been one of the earliest papers calling this pathological condition to the attention of the physician community.
Soon after arriving in New Orleans, Dr. Echols joined Alton Ochsner, MD, and the other founders of the Ochsner Clinic, all of whom had faculty appointments at Tulane University School of Medicine. When Dr. Ochsner became chairman of the Tulane surgery program, Dr. Echols became professor of neurosurgery.
Dr. Echols’ primary interest was general neurosurgery, but he was always thinking of new and innovative ideas. In the 1940s he recognized the futility of trying to open a cervical syrinx and have it remain open. To combat the problem, he used a twisted stainless wire attached to a lamina extending into the syrinx. Movements of the neck caused the wire to move, allowing the syrinx to communicate with the subarachnoid space. He also popularized the use of the tracheostomy in the management of comatose patients, particularly those with severe closed-head injury. Tracheostomy remained the standard of care until recent advances in pulmonary care, such as respirators, became available.
Known as a master of clinical diagnosis, Dr. Echols was rarely incorrect in the level he chose for surgery. He believed that at least one year should be allowed before making a decision to re-operate for “failed surgery” because most patients recovered within that time frame. He was one of the eight founders of the American Academy of Neurological Surgery, as well as its first president.
When Dr. Echols was starting his practice in New Orleans, Dr. Kirgis was a neuroanatomy instructor at Tulane University. Dr. Echols convinced Dr. Kirgis that pure anatomy was not as exciting as surgery, resulting in Dr. Kirgis becoming Dr. Echols’ first resident in the Tulane neurosurgical residency program. Dr. Kirgis joined Dr. Echols in practice at the Ochsner Clinic, but he continued his neuroanatomical studies at Tulane.
Recalling the Duo’s Distinctive Methods
A former resident of Dr. Echols’, Horace Norrell, MD, remembered Dr. Echols and Dr. Kirgis as “two men who had entirely different personalities, but remained close and respected colleagues.”
According to Dr. Norrell, Dr. Echols taught through the Socratic method, questioning as opposed to lecturing. A resident was expected to know the literature and possible surgical approaches to a problem. The operating room was his teaching laboratory, but a resident was silent until asked a question that frequently had no answer.
Dr. Kirgis, on the other hand, discussed his patients openly and occasionally would change his course of action based upon the suggestion of a resident. He was frequently in the laboratory when surgery started, and occasionally a resident would complete the surgery before Dr. Kirgis arrived.
A Gift in Repayment of a Debt
“I owe so much to Dr. Echols and Dr. Kirgis. They are responsible for my being where I am today,” commented Dr. Clifford. As he nears retirement, Dr. Clifford finds himself in a position similar to his mentors, hoping to leave a legacy of experiences, information and skill with young neurosurgeons.
He believes that making a gift to NREF in his mentors’ honor is a wonderful way to say thank-you to two extraordinary surgeons. Julian Hoff, MD, chair of NREF’s Executive Council, agrees.
“Through his gift Dr. Clifford honors the memory of two neurosurgeons of the past who molded his life in neurosurgery,” said Dr. Hoff. “His gift honors them in full measure, and at the same time supports research by neurosurgeons-in-the-making who will improve our profession through their work.”
Kristen A. Weber, AANS development manager, can be reached at (847) 378-0540 or [email protected].
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