Alton Ochsner

(Edward William) Alton Ochsner, M.D. was President of the Ochsner Foundation, and was an early anti-tobacco expert. He served as a witness for the Plaintiff in cases against the industry.

Biography
Edward William Alton Ochsner was born in Kimball, South Dakota, on May 4, 1896, the youngest child and long-awaited only son of general store owner Edward Philip Ochsner and his wife, the former Clara Leda Shontz. He would become one of the most influential medical practitioners of the twentieth century and such an institution in New Orleans that he was selected to serve as King of Carnival. Likewise, Alton Ochnser’s life was one of extraordinary accomplishments and intriguing paradoxes.

Ochsner showed early academic promise and in 1914 he enrolled as a premed student at the University of South Dakota at Vermillion. After completing the four-year program, he obtained a medical degree from the Washington University School of Medicine at Saint Louis. Ochsner then moved to Chicago, where he interned at Barnes Hospital and completed a surgical residency under the mentorship of his uncle, Dr. Albert John “A. J.” Ochsner, a distinguished surgeon and the best friend of William Mayo, the founder of the Mayo Clinic. The residency began inauspiciously, as the younger man struggled to adapt to the rigors of his uncle’s schedule. A. J. Ochsner began each workday with an early morning horseback ride, and he expected his nephew to accompany him and discuss medicine. Alton rebelled at first, telling the family that this routine was “going to kill me before we get through.” But his uncle bluntly informed him, “You are an Ochsner and you can take it,” and Alton soon adapted. Before long, he had forged the work ethic that would become one of his signatures.

Medical career
Once Alton Ochsner completed his residency in Chicago, his uncle arranged for him to do surgical residencies under two of Europe’s best-known surgeons, Professor Paul Clairmont of Zurich and Professor Victor Schmieden of Frankfurt. He spent the next two years in Europe, learning a great deal from the two eminent surgeons. But at the same time, he also made a name for himself by showing his European counterparts the value of a brand-new technique he had learned during his residency: the use of blood typing to make blood transfusions possible. According to the noted heart surgeon Michael DeBakey, by the time he left Europe Ochsner had become known as “‘the blood transfusion specialist’ of Europe.” While in Switzerland, he married Isabel Kathryn Lockwood of Chicago on September 23, 1923. Fourteen months later, Ochsner and his very pregnant bride departed Cherbourg, France, and headed for home. Two days before the S.S. America arrived on American soil, Isabel gave birth to their first son, who was named after his father. In the next five years, the family grew to include four children, and all three of the boys would follow their father’s footsteps as surgeons.

Upon his return to the U.S., Alton Ochsner practiced surgery in Chicago, and then accepted a position on the faculty of the University of Wisconsin. Then in 1926, the famed Dr. Rudolph Matas announced plans to retire as Chairman of Surgery at the Tulane University School of Medicine. Although only 30, Ochsner had already made enough of a name for himself as a surgeon to be invited to New Orleans for an interview. As surprising as it was for so young a man to be interviewed for so prestigious a position, what happened next was even more remarkable. As part of the interview process, he was asked to conduct a clinic in front of Dr. Matas and some 200 colleagues. Dr. Ochsner chose to demonstrate his technique for filling the bronchial tree and did so, then sent the patient to be x-rayed while he explained his method and the results he anticipated. When the x-ray came back, it was completely blank, meaning that the whole demonstration had been a failure. Yet rather than make an excuse, the young surgeon frankly admitted to his audience that he did not understand what had gone wrong. Despite the debacle, Ochsner so impressed his onlookers that he was offered the position. In the summer of 1927, he moved to New Orleans and began his affiliation with Tulane.

During his lengthy tenure there, Alton Ochsner became renowned for his brilliance as a surgeon and almost as well known for his uncompromising standards. Although he was typically mild-mannered and personable, medical students lived in fear of Dr. Ochsner’s “bull pen sessions.” A senior medical student was assigned to examine a patient and present his diagnosis to Dr. Ochsner, who would then pepper the student with relentless questions in front of an amphitheatre packed with students and medical staff, and doctors. But while students dreaded these ordeals, many of them ultimately came to feel that the rigorous cross-examinations prepared them to handle the stress of making life-and-death decisions.

Ochsner’s no-nonsense approach also applied to his relations with those in power. Tulane did not have its own hospital at the time, instead using the local Charity Hospital to provide clinical lessons to students. Tensions, however, began to surface soon after the 1928 election of populist Louisiana governor Huey Long, who was unabashedly partisan toward Louisiana State University, and considered Tulane an elitist institution. The new governor raised the ire of the medical community when he appointed Arthur Vidrine to serve as superintendent of Charity. Vidrine was a promising young doctor but he had little surgical experience and many believed that he had only been selected because he was a political ally of Long. Soon Tulane had lost any voice in the appointment of residents to Charity Hospital. In 1930, a frustrated Ochsner wrote in a letter to a colleague that, “the outlook at Tulane as far as building up a department as concerned is absolutely hopeless. The university is dependent upon Charity Hospital, a state institution which is in the control of politics. The university is merely tolerated in the hospital and there is no cooperation at all.” The letter mysteriously made its way into the hands of Huey Long, who retaliated by banishing Ochsner from practicing at Charity for two years. In later years, Ochsner claimed that Long had done him a favor, by giving him more time for research. But even if he indeed harbored no bitterness, the expulsion shaped Ochsner in key ways. It seems likely that Ochsner’s distaste for Long’s demagoguery played a role in his becoming a fervent anti-Communist. More directly, the experience would have a profound effect on the doctor’s view of the role of a hospital.

His ban from Charity Hospital forced Ochsner to obtain an appointment at Touro Infirmary in order to continue his teaching duties. Meanwhile, Vidrine had become dean of the newly established Louisiana State University Medical School in New Orleans, and the already poor relations between Tulane and Charity Hospital further deteriorated. Frank Riddick, Jr., believes that these events “had a profound influence on Alton Ochsner. He had been committed to the principle of full-time academic surgery, with limited consultative private practice and a role as teacher, mentor, and overseer of surgical residents in the operating room. Tulane Medical School required clinical faculty members to abjure private practice when they accepted full-time appointments. His stint at Touro brought Ochsner into daily contact with the community’s practitioners and allowed him to develop a following as the surgeon of choice for wealthy New Orleanians. He became convinced that Tulane’s destiny lay in developing a faculty practice and its own teaching hospital as insurance against future restrictions in access to Charity’s beds.”

Eventually Huey Long moved to the U. S. Senate and Ochsner’s privileges at Charity Hospital were restored. In 1935, Long was struck down by an assassin’s bullet and he died after Vidrine was unable to identify the source of his bleeding and staunch it, a procedure that many believed would have been routine for an experienced surgeon. The threat of political meddling was diminished by Long’s passing, but by this time Ochsner’s mind was made up. Tulane remained committed to the principle of the teaching hospital as a purely academic institution, but its Chairman of Surgery now believed government funding represented a greater threat to that ideal than did private funding. Just as important, his new status as the surgeon of the rich and famous gave him the financial connections to make the vision become reality.

The wife of Rudolf S. Hecht, the chairman of the board of Hibernia National Bank, was a patient of Dr. Guy Alvin Caldwell, a Tulane colleague of Ochsner’s. Dr. Caldwell set up a meeting at which Ochsner outlined his vision for a new hospital model to the banker. Hecht liked the idea so much and arranged for the Hibernia bank to lend the doctor and his four partners, Caldwell, Edgar Burns, Francis E. LeJeune and Curtis Tyrone, up to half a million dollars on the sole basis of their signatures. Just like that, the new clinic had the needed funding. As the opening of the facility approached, it became necessary to agree upon a name. Ochsner proposed the New Orleans Clinic and Southern Clinic, but in his absence the other four partners met and overruled him, informing by telegram, “The baby has a name, the Ochsner Clinic.” As Dr. Caldwell later explained, the name was both a tribute to its leading light and a concession to reality: “No matter what we named it, the public was going to refer to it as the Ochsner Clinic.”

The Ochsner Clinic
The Ochsner Clinic opened its doors on January 2, 1942. Despite the strong reservations about what it represented among some members of the New Orleans medical community, it was an immediate success. To allay some of those concerns, the Ochsner Medical Foundation was created to facilitate academic programs and research and thereby differentiate the Ochsner Clinic from other private practice groups. It has continued to expand and is now one of the country’s largest group practices and academic medical centers, encompassing a complex that includes a 530-bed hospital, a clinic, a clinical research center and an associated hotel. The new clinic increased the already high profile of its namesake. He served as physician to such celebrities as golfer Ben Hogan, actor Gary Cooper and Argentine President Juan Peron, and was even named King of the New Orleans Carnival in 1948. Yet his time in the limelight did nothing to the esteem in which he was held by his colleagues. He was chosen President of both the American Cancer Society and the American College of Surgeons, and taught more than 3,000 medical students, including over 200 surgeons.

Pioneering efforts to warn the public about the dangers of smoking
While the Ochsner Clinic was the most tangible testimony to his career, his greatest legacy may have been his efforts to warn the public about the dangers of smoking. “When I was a medical student at Washington University in 1919,” Ochsner would later recall, “a patient died of lung cancer. Our professor called us all in to see the autopsy. He said this condition was so rare we might never see another one." Instead, once he became a surgeon, Ochsner found himself operating on a steadily increasing number of lung cancer patients – and began noticing how many of them were heavy smokers. Soon the topic became a principal focus of his research. In 1935, he and Tulane colleagues Drs. Mims Gage and Kiyoshi Hosoi presented the results of a five-year study on the causes of stomach ulcers to the American College of Surgeons. Their report concluded that no known medical treatment could prevent or cure ulcers, and instead recommended lifestyle adjustments. "Excessive use of tobacco,” they counseled, “especially between meals on an empty stomach, is dangerous. Very bad is smoking in the morning before breakfast.”

The reaction to this announcement, however, paled in comparison to the ones that followed in the next few years. At the 1938 meeting of the American College of Surgeons, Ochsner and his protégé, Michael DeBakey, announced that lung cancer had become one of the most common forms of cancer and attributed the rapid increase to smoking –- specifically, “the universal custom of inhaling.” They followed up with papers on the subject in such journals as Surgery, Archives of Surgery and Surgery, Gynecology & Obstetrics and another statement at the 1940 Annual Clinical Congress of the American College of Surgeons. To support this claim, Ochsner pointed out that it made sense for smoking to be "a cause of cancer of the lung because we know that chronic irritation is a factor in the incidence of cancer and we know that smoking causes cancer irritation.” For statistical evidence, he noted that cigarettes sales and the incidence of lung cancer had both been rising steadily for twenty years, while automobile sales – which were sometimes cited as a suspect – had declined after the stock market crash without a corresponding decrease in lung cancer cases.

Opposition to Ochsner's statements that smoking causes cancer
This was hardly incontrovertible evidence, and the statements Ochsner made were suitably modest. “I am not condemning smoking,” he commented in 1949 at the first National Cancer Conference, “but it is a factor responsible for the increasing incidence of lung cancer.” And, as befitted a practicing surgeon, his focus remained on finding a cure to lung cancer. In 1942, he reported that removal of a cancerous lung increased the length of survival by months or even years. And in 1953, he told a conference of physicians, “I don’t believe any of you fellows will give up smoking because I say tobacco causes lung cancer … If you must keep smoking, I recommend a chest X ray at least every six months –- preferably every three –- so a surgeon can get to you soon enough if trouble does come.” He expressed optimism that same year that, “If we can determine the presence of lung cancer before symptoms develop, we can save almost every patient by removing his lung.”

Despite the temperate nature of this message, many within the medical community reacted strongly. “For every man who says that smoking causes cancer,” stated Dr. Charles S. Cameron, the medical and scientific director of the American Cancer Society, in response to Ochsner’s remarks at the National Cancer Conference, “there is another to say it doesn’t. The point has never been proven. It is purely in the realm of speculation.” Ochsner’s statement also put him at odds with one of his mentors, Dr. Evarts Graham of Washington University of St. Louis. Like many physicians, Graham believed that causation could only be established by hard evidence of a specific mechanism, and he was distressed to see one of his pupils relying upon conjecture and statistical evidence. "Yes there is a parallel between the sale of cigarettes and lung cancer,” Graham commented derisively, "but there is also a parallel between the sale of silk stocking and cancer of the lung.” Ochsner may have been somewhat chastened by the rebuke, as he seemed to back off on some of his earlier claims in his next published work on the subject in 1947. Nonetheless, like all surgeons, he was continuing to deal with an ever-rising number of lung cancer patients.

Political activity and the FBI
By the 1950s, Alton Ochsner was also being stretched thin by all of his responsibilities and had to start choosing between them. In 1956 he stepped down as Tulane’s Chief of Surgery, and then in 1961 the school terminated his teaching position, citing a conflict of interest with the Ochsner Clinic. These years also saw Ochsner become increasingly active in political and social causes, especially as a passionate and vocal opponent of Communism.

The FBI’s file on Alton Ochsner, which is now accessible through the Freedom of Information Act, shows that he began doing medical research for the U.S. military during World War II. In the mid-1950s, he again did consulting work for the U.S. Army and the U.S. Air Force, and in 1957, the FBI cleared Ochsner for a “sensitive position.” Two years later in October of 1959, the FBI again cleared Ochsner for a new assignment with an undisclosed agency. The nature of Ochsner’s work in these assignments remains classified, and they may well have had little or no political component. But what is beyond doubt is that he was deeply upset by the 1959 Cuban Revolution, which served to harden his political conservatism. Taking advantage of New Orleans’ extensive trade ties to Latin America, Ochsner had long treated and befriended the leaders of Central and South American countries. Like many Americans, he feared that Castro’s revolution would spread throughout Latin America and devastate the economy of the United States –- and New Orleans in particular. Unlike most Americans, he believed he could do something about it.

Crusade against communism
An ever-increasing amount of his time began to be spent crusading against Communism. In 1961, Ochsner became one of the founders of INCA, the Information Council of the Americas, and served as its President and Chairman. INCA’s mission was to prevent any more revolutions by educating the Latin American people to the evils of Communism. But as the sixties brought widespread social change, INCA’s goal of creating a broad-based coalition against Communism gave way to affiliations with a wide range of organizations representing the extreme right wing of the political spectrum. Alton Ochsner’s fame and connections brought credibility to these activities, but in the process his image as an impartial man of science was tarnished in the eyes of some.

Despite the extremism of his allegiance to capitalism and big business, Ochsner didn’t waver in the least in his attacks on the tobacco industry. Throughout the 1950s, a mounting pile of evidence linked smoking to lung cancer and many doctors were rethinking their views on the matter. Surgeons such as Ochsner became particularly frustrated, as they treated more lung cancer patients than ever and became increasingly pessimistic about the efficacy of chest x-rays and lung removal. By 1958, he had abandoned his earlier conciliatory tone and gone on the attack against those who questioned the link between smoking and lung cancer. “I do not know a single doctor who rejects the evidence,” he declared, “except those who are affiliated with the tobacco industry and those who are addicted to tobacco themselves.” He noted that 98.5% of the lung cancer patients he had treated had been heavy smokers, and scoffed at the excuse that such evidence was based only on statistics. “Everything in life,” he stated bluntly, “is based on statistics.”

Frustration with the slow response to epidemic of smoking-related deaths
In the ensuing years he became increasingly impatient with the slow response to the epidemic of smoking-related deaths. A 1961 article that described him as the “nation’s most outspoken cancer expert” quoted Ochsner as saying that he was “fighting the cold war through medicine.” And indeed the surgeon’s escalating rhetoric suggested that he was at war with the tobacco industry and with anyone in the medical community who disagreed with him. When asked that same year if filters reduced the risk of disease, he replied caustically, “Filters do help – help to sell more cigarettes.” He also called on life insurance companies to raise the premiums of smokers and urged the tobacco industry to put warnings on cigarette packages. By 1964, he was calling for the government to mandate warning labels and to place limits on cigarette advertising. His harshest words, however, were reserved for the American Medical Association, which he accused of being “derelict” for using “delaying tactics” instead of taking a firmer stance against cigarette smoking.

In 1966, with Dr. Ochsner approached his 70th birthday, one of his colleagues reminded him that a rule he himself had instituted prohibited surgeons from practicing after the age of 70. At first, he was indignant and wanted to have the rule changed, but eventually he decided to abide by it. Yet he could not resist a show of defiance, recalling later that, “On that last day, I performed 13 operations just to show them I still had it in me.” Those operations concluded a surgical career that had seen him perform over 20,000 surgeries.

Even after performing his retirement from surgery, Ochsner continued to direct operations at the medical center and to crusade against smoking. In 1970, the man who had once believed that nobody would give up smoking because of his warnings published a book with the alarming title of Smoking: Your Choice between Life and Death. And in 1974, after years of making gloomy predictions about massive death tolls and being ignored, he tried a new tactic to get his message to young people by warning them that smoking would affect their sex lives.

Isabella Ochsner died in 1968 and the doctor was remarried to Jane Kellogg Sturdy Ochsner. His second wife shared his deep connections with conservative politics. When it looked as though passport problems would interfere with their proposed honeymoon in Greece, she called the White House and asked to speak to “Dick” Nixon. She soon had the papers she needed.

Alton Ochsner died on September 6, 1981, one day after undergoing heart surgery at the Ochsner Medical Foundation Hospital.

Additional biographical information
Biography Index: A cumulative index to biographical material in books and magazines (many editions).
 * American Men & Women of Science. A biographical directory of today’s leaders in physical, biological, and related sciences (many editions).
 * The International Who’s Who, Who’s Who in the South and Southwest and Who’s Who in America. (multiple editions).

Key publications by Alton Ochsner

 * Alton Ochsner, Smoking and Cancer: A Doctor’s Report (1954).
 * Alton Ochsner, Smoking: Your Choice between Life and Death (New York: Simon and Schuster, 1970).
 * A. Ochsner and M. DeBakey, “Primary Pulmonary malignancy: Treatment by total pneumonectomy; analysis of 79 collected cases and 7 personal cases,” Surgery, Gynecology & Obstetrics 48 (1939): 433–451.
 * A. Ochsner and M. DeBakey, “Carcinoma of the Lung,” Archives of Surgery 42 (1941): 209-258.
 * A. Ochsner and M. DeBakey, “Surgical Considerations of Primary Carcinoma of the Lung,” Surgery 8 (1940): 992.
 * A. Ochsner, M. DeBakey and L. Dixon, “Primary Pulmonary Malignancy,” Annals of Surgery 125 (1947): 522.

Media Coverage of Ochsner and his work

 * “Smoking Before Breakfast Blamed for Stomach Ulcers,” Chicago Tribune, October 29, 1935, 7.
 * “Tobacco Smoke Inhaling Seen as Cause of Cancer,” Hartford Courier, October 19, 1938, 6.
 * William L. Laurence, “Lung Cancer Rise Laid to Cigarettes,” New York Times, October 26, 1949, 17.
 * Howard W. Blakeslee, “Surgery Gains In Fight on Lung Cancer,” Washington Post, March 7, 1942, 22.
 * “Influenza May Disguise Lung Cancer,” Los Angeles Times, February 27, 1949, 23.
 * “M. D. Bows to Human Nature,” Dallas Morning News, March 20, 1953.
 * Helen Bullock, “Famous Surgeon Cites Ills of Tobacco Tars,” Dallas Morning News, September 21, 1953.
 * Helen Bullock, “Foe of Cigarettes Criticizes Doubters,” Dallas Morning News, September 25, 1958.
 * Ed Cocke, “Smoking Attacked By Cancer Expert,” Dallas Morning News, June 8, 1961.
 * Frank Hildebrand, “Dr. Ochsner Asks Life Firms’ Aid,” Dallas Morning News, October 18, 1961.
 * “Increase Seen in Fatal Cancer,” Dallas Morning News, June 8, 1961.
 * “AMA View on Smoking Defended,” Dallas Morning News, March 24, 1964.
 * Helen B. Callaway, “22 Million Have Quit Smoking, Doctor Says,” Dallas Morning News, November 4, 1972.

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