Fletcher H. McDowell, MD, 1923–2017
Fletcher commenced his remarkable and influential career with his medical training at Cornell Medical College in 1945. Following graduation in 1947, he began an internship in internal medicine at Cornell, and then went on to a medical residency at Stanford. He returned to Cornell as a Resident in Medicine (Neurology) in 1950. After a 2‐year stint in the U.S. Army Medical Corps and a year as a Clinical Clerk in Neurology at Queen Square, he came back once again to New York Hospital/Cornell, where he was to spend the remainder of his career. From 1956 to 1967, Fletcher was the Physician‐in‐Charge of the Cornell Neurological Service at Bellevue Hospital in Manhattan. In 1973, Fletcher was named Chief Executive Officer and Medial Director of the Burke Rehabilitation Hospital in White Plains, New York (then affiliated with New York Hospital and Cornell). In assuming this role, he brought rigor and high clinical standards to that institution and to the entire field of physical medicine and rehabilitation. In 1975, he was named Winifred Masterson Burke Professor of Rehabilitative Medicine and Associate Dean of Cornell University Medical College.
Fletcher was a quiet, almost unassuming, and practical man. His passion was for the care of patients and helping them live as best they could in the face of their neurological disabilities. He sought little credit for his accomplishments. However, his pioneering vision and his quiet, confident, and calm leadership in multiple areas of neurology encouraged multiple generations of neurologists to follow in his footsteps. He encouraged his students, mentees, and colleagues to innovate and follow their own passions in the service of patients with neurological disability. A compassionate, caring, and personal physician, he made house calls when his aging and severely impaired Parkinson patients were home bound.
Fletcher recognized immediately the significance of George Cotzias' observation that slowly titrating oral L‐dopa dosage allowed patients to tolerate sufficient doses of medication to ameliorate their Parkinsonian symptoms.1 He and his group executed and published one of the first clinical trials with L‐dopa.2 Fletcher later persuaded Cotzias to join and enrich the faculty at Cornell. Fletcher and his team followed their initial study with the recognition that motor response fluctuations were related to plasma L‐dopa concentrations,3 that the use of carbidopa increased the effectiveness of L‐dopa,4 and that sustained‐release L‐dopa preparations were necessary.5 Perhaps most importantly, he and a succession of colleagues at Cornell carefully tracked the progress of the initial cohort of L‐dopa–treated Parkinson patients,6 and collaborating with centers from across the country demonstrated the positive effects of L‐dopa treatment on the natural history of Parkinson disease.8 His group's landmark 1972 paper demonstrated that cognitive impairment was not only common, but a nearly universal clinical aspect of the clinical course of Parkinson disease.9
Parkinson disease was not the only area in which Fletcher made major contributions to neurology and medicine. He was an early promoter of the concept that more attention should be paid to stroke. He was a founder of the journal Stroke and served in editorial roles from 1970 to 1981. He formulated consensus positions for the diagnosis and treatment of stroke.10 Significantly, in the relatively new arena of the active treatment of patients with chronic stroke, he waved off the passive protocols requiring patients with stroke to be treated with rest, quiet, and only passive movement of the affected limbs. He could never understand why patients spent so much time lying in bed.