[Eleanor MacDonald] Excuse me, honey, and go ahead.
[Louis Marchiafava] Today's date is May 19th, 2000,
this is Louis Marchiafava
interviewing Miss Eleanor MacDonald,
for the MD Anderson Cancer Center oral history project.
I'd like you to say just a few words
and make sure our equipment is working.
[Eleanor MacDonald] Talking to me and let me speak. (laughing)
[Louis Marchiafava] We'll find out.
Mr. MacDonald,
I'd like to begin the interview
by getting some background information
or can you tell me about your educational years?
What did you specialize in the career in university.
[Eleanor MacDonald] I got my degree in music.
I intended to be a chorister and I
played professionally for three-four years.
Then I was at a summer job at Lake George,
a beautiful job an hour and half playing a day,
I was going to get over my college fatigue.
I had taken civil service exams
and I thought that I might pass in
case I ever needed a job.
I came up on
the list to
the Division of Adult Hygiene was just beginning.
It had to be called that because they couldn't
use cancer in 1930,
couldn't use the word cancer.
That was given on the radio wasn't allowed until 1936.
While I was working there for
Dr. Lombard who was conducting,
Herbert L. Lombard, the director of Adult Hygiene.
This is going to seem like a detour,
but it's very important.
None of the people in public health thought
that cancer was a preventable disease.
Therefore, it had no place in public health.
But by a fortuitous set of circumstances,
everyone that was in Massachusetts at that time,
the people influential on starting
this or believed passionately that it could be prevented.
In George Bigelow, there's more pastors,
a group of people in Boston that come from
wealthy backgrounds and they inherited jobs at Harvard.
Also, they take it off for granted.
But some of them,
spend the life-giving service.
One such man was Dr. Robert B Greenough.
G-R-E-E-N-O-U-G-H.
He and Dr. Joseph Bloodgood,
both of it sounds from
Johns Hopkins established the College of Surgeons,
and they did it because
anybody could offer it that had a doctor's title,
whether we got it at good school or quiet school,
anything, that was a terrible situation.
[Louis Marchiafava] What year was this?
[Eleanor MacDonald] Was 1911, I think it wasn't as they formed.
But in 1917, these two men
had noticed for the first time,
each one of them is a study of cancer of
the breast that operated on by the radical procedure,
the Halstead procedure just came in about that time.
[Louis Marchiafava] Halstead.
[Eleanor MacDonald] H-A-L-S-T-E-A-D.
He was the one that recommended in
continuity surgery taking
the axillary nodes and the breast,
the whole breast tissue very radical.
But it was the only thing for a long time
that gave any good results.
Largely because most people came late.
They didn't come in time to get it early.
Anyway, these two men
made these studies in their own place.
Each one had just a few well, like 103,
107, and two places entirely separately.
In those days to make a study of
anything beyond the current year,
you had to go to the attic and place
last year's records in an old shoebox or something.
No organized record systems
in this time, up until this time,
so that to make studies up until
1970 was a heroic effort on the part of the men that did.
Both these men did it,
and they traced every one of those patients.
The death certificates, family,
doctor pass reports the whole thing.
Then they took the big yellow sheets
that people used to work on,
and they put the months or years of survival.
All of a sudden, they
noticed that in cancer of the breast,
the first year, many deaths,
the 4th year many deaths.
If you got that, the 4th year, it stopped.
It means you are clear,
and that's the first hopeful sign they had.
That five-year survival for cancer of the breast.
If you lived through the fourth year,
you are usually safe.
They decided that lastly at
hopeful thing and they brought this up at the 1970.
Nobody knows this but we, I mean,
I've been told by these men
it's going to be in my book too.
They brought this up at
the surgical meeting that
now we have something optimistic to say.
[Louis Marchiafava] What year again?
[Eleanor MacDonald] There's 1970, the American Surgical Society,
and it was greeted with loud enthusiasm
because everybody saw that it
meant little ray of openness,
so they worked right then in 1911,
they formed the College of Surgeons to
investigate criteria for surgery,
and you had to have firm criteria and
everybody was told to
get a member of the College of Surgeons.
In the first it was political.
It was really wonderful what they did to clear
up all these cracks that we're operating in.
Many of the people will not experience or training.
It went from there then they said,
that reasoning, I've seen some of these meetings.
What good is good surgery if you
don't have an antiseptic hospital,
so they started to work on Hospital Association.
Then they set up cancer clinics and it happens to be
a man named Ian MacDonald in
relation spelled the same way as moldy.
He gave up a number of years of
his lucrative surgical practice and went
around examining clinics all over the country,
and to be approved
American College of Surgeons cancer clinic
was (inaudible) an open sesame to the best,
everybody would go to those clinics.
They were very difficult to get approved.
But you see, they did everything together.
They went to the Hospital Association and establish that.
Then sent this man around,
examine the hospital situation.
It was really a marvelous concerted action effort.
Well, this was all going on in the background.
But Robert B Greenough was one of the famous men from
Boston that gave up himself and his time and his money.
He was a Harvard professor
when he specialized in cancer of the breast.
He was a friend of my father's and he wrote a paper or
prepared a paper in which he said
cystic metastasis was pre-cancerous,
and it isn't the cause of first everybody sometime.
But he thought it might be because they're looking for
causes and didn't publish it.
But he wanted to have helped in correcting it.
He called my father and asked me if he'd send
me over to study with Bidwell Wilson,
the only man in Boston at
that time that was doing small sample studies.
What they call the Linear Fisher method.
His design of experiments by
Ronald Fisher came out in 1927,
so this was brand new.
I got into this when I came into this thing.
Your father knew Dr.
Greenough and I walked into this division.
The Commissioner of Health,
George Bigelow, didn't take a salary.
He was a political,
which is very rare thing in the Commissioner of Health.
If nobody could pull him, he could walk out.
He believed that cancer was preventable.
That's only by all these and Lombard,
the first one to hit the division
that had rhabdomyosarcoma,
which was universally fatal at that time.
He had been two years,
and he left his lucrative practice in Maine,
came to Boston, and studied
with his level (inaudible) to learn these methods.
This particular group, Greenough,
was the chairman of
the cancer committee in Massachusetts.
They believed cancer was a preventable disease.
Commissioner of Health, Lombard they can't
secure wanting to do something for
cancer patients before he died.
(laughing) It was such an idealistic group.
Can you take an idealistic kid, you know,
drop him in that mixture and the size limits
you just give your life, and that's what it was.
From the first minute I got in there, I was inspired.
[Louis Marchiafava] How old were you at that time?
[Eleanor MacDonald] I was 22 when I graduated from Radcliffe in 1928,
and this was 1930.
Just after my 24th birthday,
I worked in this cancer division.
After Greenough brought me out to Dr. Wilson and
Wilson for me and he was
a very difficult presenter of material.
He`s a little pompous, Louis,
I don't want to say anything negative about him
because he'd been just wonderful to me.
But he was uneasy
with the fact he was a Harvard professor,
he is pleased about it as he has every right to be.
Well, he started tutoring me that night
in statistical methods and he said,
"You have an aptitude and we're absolutely desperate,
to have somebody in this field.
I match my time with yours if you let me train you."
I said, "What does that mean?"
He said, "Five nights a week,
three hours a night for three months,
no social life at all,
and that I was working days.
(laughing) All right, I hadn't had much social life
anyway up to that point.
I thought about it for about five minutes
and opening up opportunity.
Why feel I know nothing about opening up,
being educated by the top man in the field,
so I said yes and I had
an agonizing three months of exhaustion and study.
At the end of the three months,
this was coincidental,
the cancer division had an exam for
Principal Statistician and I took it,
and got 96 of course with the training I just had.
A Ph.D. in mathematics class (laughing),
75 and that was the next mark.
So they had to consider me,
but you had to be according to
civil service requirements in order to
be in a supervisory position,
you had to be 26 years old,
(laughing) and I was 24.
So they had to go before the governance council.
Now that's (laughing) and in two years after that,
they never had a non-medical epidemiologist?
I don't know, I
had learned papers and everything by that time,
writing was like a gift,
wasn't going into this thing.
That's what they wanted me for I was a writer.
Things went on from there and I was encouraged,
I had 100 papers published in the first ten years,
46 of them moving into general medicine.
[Louis Marchiafava] Under the auspices.
[Eleanor MacDonald] Of different groups,
the Medical Society and I was
an unwritten rule in the mass Medical Society.
[Louis Marchiafava] What kind of society?
[Eleanor MacDonald] Massachusetts Medical Society.
[Louis Marchiafava] I'm sorry.
[Eleanor MacDonald] I was the unofficial Status Statistical Consultant
, by that I mean,
I wasn't on the letterhead,
but everybody that had a statistic in
this paper had to go over my desk.
That was, of course, Shields Warren,
was later the head of the Atomic Energy Commission,
was very much interested in me at that time.
I will say, it's supporting
my younger sisters that's why everybody helped
me because they knew I had to have
a little help I could get and I
got it from everybody I met.
[Louis Marchiafava] What year did you come to Anderson?
[Eleanor MacDonald] Nineteen forty-eight and Dr. Clark was
getting a ground somewhere in the middle of 40,41 and 42.
Every Saturday I started going over with
all my good friends at the memorial because
there was nobody trained like I was to set up
studies and I got carried away with,
I charge them $50 a
week and I set up a planned (laughing)
statistics training for people
encoded to a 200 item code,
every record in memorial from 1935,
I was working three or four days and every
night of the week when I go home from there.
[Louis Marchiafava] You were working at Memorial hospital?
[Eleanor MacDonald] Yes. Weekends.
[Louis Marchiafava] Weekends.
[Eleanor MacDonald] I was a statistician
in the Connecticut State
Department of Health for all that time.
[Louis Marchiafava] Okay. But Memorial Hospital was in Connecticut?
[Eleanor MacDonald] No, Memorial Hospital in New York,
Sloan Kettering Memorial it became.
[Louis Marchiafava] All right.
[Eleanor MacDonald] It was the most famous hospital in
the country and all the men
there went into it when it was
a very difficult field to go into.
They were really tremendous miscible consult,
but they knew me.
[Louis Marchiafava] Well. I'm trying to
establish the
connection between(crosstalk) you and Anderson.
[Eleanor MacDonald] Here is the connection between
a very peculiar connection.
I was the first published one in my class at
Radcliffe and the editor,
rather wise editor,
of the Radcliffe Quarterly,
asked me if I could write a paper in 1800 words or less,
I told the thought process
they went into a research study,
and because I left, right, left,
that and I wrote
the paper and I brought it over to Shields Warren,
he said it's really very good Eleanor if I
going to change the title and
change it to fundamentals of
[epidemiology and I said] "You're
sending me back to the work table
and it could be better."
Well, all I knew at 24,
which I was then about research methods,
what I had just heard and listened to
these inspired people who I
was clapping up everything
they said and I thought they were all heroes,
especially Wilson and Shields Warren,
they were both so good to me,
and I had all that special training with Wilson,
but I was very lacking in the mathematics department.
My concentration at Radcliffe was
music and at the end of my sophomore year,
I had fulfilled the requirements,
combined with my work at
the conservatory, played the job,
and so for the last two years,
my mother had died,
(inaudible) selected me to choose
professional accompanist and we were going to group,
put together to jive buck two weeks
before my first big public appearance.
There were six of us and we were all
desolate for this loss.
Then after that, I had to take care of the house,
and my father thought I had to leave school.
Everybody agreed to work together,
so I wouldn't have to leave
two little children six and seven,
and a girl 12 and I was 16,
(noise) and my brothers were 21 and 22.
They were both in college.
It was a stressful time in some ways,
but these people caught on to this,
some of these kind people like Shields Warren,
I didn't tell him, but he found out
some way and every one of them helped me.
When people said, " Don't you have
a hard time in a men's world."
I never had a had time,
I just can't imagine the cooperation everybody gave me.
But that Radcliffe Quarterly paper,
they had all the bright scenes of
Wilson and he was good to
everyone lines and Shields Warren,
I just gave my heart to it and it ended
with the true epidemiologist,
feels no urgency to rush into print,
until the full maturity of
his analytical reasoning is attained.
Of course, it was published
in French in the League of Nations bulletin.
That takes me, by 1934 - 5 (laughing),
and I got 500 requests for reprints within two months.
Most of my life, I never got anything.
That's a very unusual number (background) of requests,
so in my little paper,
up till three years ago,
I've been asked for copies of it
for epidemiology classes around the country,
and of course, I just take it
over to the Xerox and have it copied,
but isn't that interesting?
Shields Warren, not Shields Warren,
but Hayes Martin the that
started statistics at Memorial
and the head and neck Surgeon,
sent me his leave papers
and asked me if he handled the data right.
(inaudible) Patterson you've heard of him,
he's the one that taught
Gilbert Fletcher radiotherapy, the primary teacher.
He taught all the ones that even my
generation that were adequate,
he became gear personal friend,
he and his wife and Scottish and they
both did it with one very outstanding team,
pediatricians in the worlds so they were great,
great family and they were very good to me.
[Louis Marchiafava] How did you make the connection with Emily Anderson?
[Eleanor MacDonald] I was getting the grand circuit because,
I was really a consultant to Memorial every week
and they came to me
for all the studies practical, and the clinical studies.
It's not exaggerating to say
that my life was about 22 hours of work (laughing),
and about two hours to sleep,I enjoyed
it and I was over there and Dr. Clark was there,
it was sometime in September,
I think it was shortly after he was appointed in 1947.
He was getting the grand proper treatment,
I was going to get to the director will be
offering a big job over there.
Well, I knew I was going to take it.
They were all my friends and I had
to go through this about every year
because I liked what I was doing in
Connecticut and tied in,
anyway, he was there that day and Hayes Martin,
had never gotten the principle of
IBM equipment and I
tried to explain that I simply
couldn't handle all the records everywhere there,
I had had punch cards since 1930,
Remington Rand when they were
45 lines and all that so I'd
always had mechanical equipment to
handle the big bundles of stuff I was working with,
Angus, is he bothering me?
[Louis Marchiafava] No.
[Eleanor MacDonald] So Hayes Martin sending me this stuff for the memorial,
that made that connection.
So he asked me if I come over
every weekend and help them with their studies,
so I came over as a weekly consultant
for the last three or four years I was here.
In Connecticut I built
the first cancer record registry and
follow-up program for
the whole population anywhere in the world.
It was the very first one
and I built it in a year-and-a-half after I left
Massachusetts and when they found
1800 people alive that
the doctors themselves saw what we did,
they went to the state legislature in
two days and then raise 50,000 to set
up paying people to
follow up in Connecticut and it was the sample,
the patterns for everywhere and of course,
Clark heard about this.
Everybody has heard about it,
so he came,
he was at the Memorial
where they were getting the ground wrong.
I heard this soft voice,
Texan behind me,
we'd see when I come out,
he'd go in or vice versa.
At lunchtime, he went to lunch in
the cafeteria there with
a pathologist that he went to school with.
I went with Hayes Martin,
and they came together to sit at the same table.
Dr. Clark said, "I
can't be bothered with this punch card stuff.
Have a node in the neck, put a punch in the
card," in his soft voice, a Texan,
whose name I hadn't picked up, said,
"You just don't understand the principle."
He talks so low,
like all great big administrators that you
had to or you missed something.
So Hayes Martin has sort of a manner,
he had a slight impediment.
He got the floor, he didn't give it up very easily,
really a very fine man,
but he quieted down then.
Here this character, who I'd never seen before,
told about how he was going to
the Mayo Clinic and he was in
the colon-rectal area and
he wanted to know what had happened to all the patients.
He personally went into the records and got
all this stuff out for
all the records of colorectal for a 10-year period.
Then he went and got the slides,
and where he didn't find the original slide
on which the diagnosis was made,
he went back to the original specimen,
took the next slide.
Now, I look at somebody that does studies like this,
(laughing) I thought I was the only one,
I'm completely interested in what he was saying.
Doctor, that afternoon when I went
to get the final papers from Hayes Martin,
he said, "Even punch cards."
So Lee Clark had sold him on
punch cards because when he got all his stuff assembled,
he put it on punch cards himself.
He had learned how to use all this equipment.
The next morning, when I
got into my office in Connecticut,
he was there ahead of me,
and I was about 15 minutes late,
8:15, and they start early,
and here was Lee Clark sitting by my desk.
He said, "I'm just setting up a program in Texas.
I've got my meeting with the Board of Regents tomorrow."
Then he said, "You've been in the Massachusetts Program,
Connecticut Program,
and perhaps you could help me with this."
(laughing) I said to him facetiously,
"They're not going to ask you for your
program." So what are they going to?
I said I'd met with Board of Regents and
governance councils off and on for the last 15 years.
(laughing) They will say,
"My uncle came from Deaf Smith County,
he had cancer of the tongue.
What are my chances of getting it?"
I picked Deaf Smith because I
thought that was such a funny name.
There are 243 counties in the state,
but that happens to be where Dr.
Lee Clark was born in (laughing)
[Louis Marchiafava] What is the name of the county?
[Eleanor MacDonald] Deaf Smith. (crosstalk) He's an old Indian guy,
instead of calling him Deaf Smith,
he's always known as Deaf Smith,
and it's Wichiter or Wichita Falls, whichever there,
(crosstalk) that's where Dr. Clark was born.
He was interested in that and what he said was,
(laughing) shall I tell you.
(crosstalk) It won't look very well on the program.
[Louis Marchiafava] It's all right.
[Eleanor MacDonald] Jesus Christ.
What he say,
(laughing) it struck me
because I would never take the name of the Lord
like that but he was horrified,
and I said to him, "Well."
He said, "I wouldn't know what to answer to that."
When I was first in Connecticut
during those '41 to '45 war,
everybody was volunteering for war worldwide.
I had a first cousin who was one
of the vice presidents of (inaudible),
and he got the presidents and vice presidents to
volunteer because I believed I needed some help.
They didn't want them rolling bandages so they called me.
Victor called me and told me what he had done.
So I called him and said,
"If these people come, I could use them."
So there were eight of them.
I said, "But we can't do this on a now-and-then basis.
It's got to be regular like
every Thursday night for a couple of hours.
You could be a great help because I only had one
assistant," and they came.
I said, "Bring your slide rules,"
and we were in the school rooms,
(inaudible) for two years, those men came.
What I did was gather every bit of information I could
about cancer mortality by
this total breakdown that you get from Washington.
Defective as it was, it was the best we
had for different places,
and these men assembled it.
My work has got the populations
of everything that had to be done and I
taught them how to figure
standardized rates so that we
can make one rate comparable to another,
and these men did
the standardized age-adjusted rates
by every site of cancer by male,
female, white and black,
for every county in the United States.
[Louis Marchiafava] Is this what interested Lee Clark?
[Eleanor MacDonald] Sure. He said, "How I answer this? "
I got the 254 Texas cards out,
pulled out Deaf Smith County,
pulled out the cancer,
the cancer wasn't of the tongue,
and showed him how he'd figure from
that, from that information.
He had in Deaf Smith county,
how many people died from cancer.
That's how you could configure
that adjusted rate to figure
what your chances were of having it.
It's a little complicated,
but it can be explained.
So he sat there that day and he said, "Say,
it's leukemia from El Paso county?"
So we pulled out the leukemia card.
Well, in that afternoon,
he was a very apt student,
but he was there at eight o'clock in the morning,
we never even went to lunch. He didn't want to leave.
He wanted to get this because he
had to have it ready the next day,
and so he did. I let him take that.
Then at the same time,
the hospital associations send me
listings of all the hospitals in the country by size.
Shell Oil gave me
three sets of maps of every state by county.
That was revoked, during the war you couldn't get maps
of gas stations during the war in this country,
so they sent them to me for research purposes.
My intrepid presidents and
vice presidents of the insurance company
colored in in every map,
all the counties that had
no general hospitals of any size.
So I pulled that map out,
there were 68 covering
a big proportion of Texas
that didn't have hospitals of any size.
He said, what use could I make of this?
I said, I don't know. Every other state
handles the communicable diseases first,
and we have tuberculosis as rampant in this state.
But you have a talking point in
the fact that there's 68 counties with no hospitals,
that you must have a cancer center
because there is a lot of cancer here too.
He was writing all this stuff down.
(noise) I gave him the map,
I gave him all the cards intending to get them back.
I never got them back by the way,
it was too much for him.
He want the (inaudible) (laughing) I was there,
I could have gotten them, but he never returned.
He broke my set. Anyway, I shouldn't tell that.
So that's how and he offered me a job that day.
[Louis Marchiafava] Same day?
[Eleanor MacDonald] Yes, and I said to him,
I'm thinking of making a change because
it's all established here and I'd like to go into
some other pioneer program, so I'll think about it.
But I didn't think I wanted to come to Texas.
I had taken a trip from
Connecticut through to California,
and then I entered Texas at Texarkana
and I didn't see a bird all the
way from Texarkana to El Paso,
just the worst part of the state,
and I thought, "Oh, a horrible place."
My sister and I were interested in birds and
we'd taken this adverse trip,
two months' leave of absence,
worst vacation we ever had, my sister Mary.
So we got to El Paso and we were all
familiar with the beautiful balance of
rows of the Rio Grande and all these other songs.
Cattle were in the riverbed,
there wasn't any water. We were so mad.
We just didn't stay in El Paso,
we went to (inaudible).
(laughing) Texas was a blank as far as we could see,
(laughing) but because I hadn't seen
Houston or Dallas or any of the other places then.
[Louis Marchiafava] When did you first see Houston?
[Eleanor MacDonald] He invited me down
to the Post Graduate Medical Assembly,
and the first total figures
on cancer incidence in the United States for
a regular population were given at
the Post Graduate Assembly in 1947, in Houston.
[Louis Marchiafava] So that's when you got to see him again?
[Eleanor MacDonald] Yeah.
[Louis Marchiafava] Did he repeat the offer to you then?
[Eleanor MacDonald] Oh, did he? I had no intention of coming.
You see, I did the first registry.
Then 1946,
I had got all this information for all the states.
Dr. Parran, the Surgeon General,
asked me if I could,
since the Connecticut program
was all rounded and so effective,
could I adapt to
suggest what could be done in every state?
Well, I had all states. I had all my colleagues.