[Louis Marchiafava] Continuing interview Side 2.
We were talking about he invited you.
[Eleanor MacDonald] Yes. He asked me if I would come down.
His very words were considered
Connecticut a pilot study
because it's just the size of Harris County.
We have 254 counties (laughing) in
Texas so come down and
do the same thing for Texas that you did in Connecticut.
That was an interesting thought and
I kept it back of my mind.
But in '46,
Dr. Peron was going to publish the document,
making a recommendation for
the next 25 years for
cancer divisions in state health departments.
He asked me if I could get him this information.
[Louis Marchiafava] This was Dr. Peron
[Eleanor MacDonald] Tom Peron, the Surgeon General.
P-E-R-O-N. Really a very progressive Surgeon General.
I thought he was wonderful.
He had appointed George Smith from New Haven.
Dr. George Milton Smith who
was a great man in the cancer field background figure.
He's a historian himself.
But anyway, he appointed him in
charge of a committee to determine what
would be the cancer program for
the whole country in the next 25 years.
Of course, I was working with Dr. Smith.
My assistant was working on his grant,
married and running the tumor registry
in New Haven Hospital and I was running
the state registry that built the hospital
(inaudible) and it was every hospital was cooperating.
Smith was interested in what I was doing,
and I was interested in his interests in gastric cancer.
At that time I was working a lot on that.
He had been since he was a boy,
he was interested in the stomach.
When he was eight years old,
he had scarlet fever.
His father was a China trader.
His mother was one of the Anaconda Copper family heirs.
He's a very wealthy man
and he had to go into quarantine in China for six weeks.
He had scarlet fever
and he could take one book with him,
then he took the anatomy of the stomach and I said,
"Are you sure you're only that age?"
He claims he was only that age
and he had to read it over and over.
[Louis Marchiafava] Now, how old would he say he was?
[Eleanor MacDonald] He says he was eight or
something like that. Very young age.
But whatever it was, older or younger,
the age year wasn't given.
He did it because it was engraved to
the anatomy of the stomach was in his mind all his life.
He's the first one that got artificial tumors.
First time they were reproduced except for in mice.
Even in mice, other than breast cancer,
first one that produced
a tumor were done under his aegis.
[Louis Marchiafava] This was again his name?
I want to sure I heard you right.
[Eleanor MacDonald] George Milton Smith.
[Louis Marchiafava] Okay.
[Eleanor MacDonald] You'll figure in my story.
His picture is in my living room. (noise)
[Louis Marchiafava] What did you do with (crosstalk)?
[Eleanor MacDonald] He was the Chairman of
the National Advisory Cancer Council.
I went home, went back,
and gathered my data,
and I had a very good secretary
that typed direct figures everything.
I just set up form,
circled the parts of the state whether they had
a medical society committee and then
the clinics and then the various population questions,
and made digital copy for each state.
Assembling all the material in my lap all through
just like I did Connecticut to see. But it was all there.
You see I had the (inaudible) cards
and in one week
we had that done for the whole country by state.
It was published in the Journal of
the National Cancer Institute in April 1946.
[Louis Marchiafava] This is the event that must have or did
it encourage Dr. Lee to have you come here?
[Eleanor MacDonald] Probably. Well, he
wanted to have a registry because he knew
they were going to be the in
thing because Peron was talking about it.
He hadn't been to see Peron.
Here I was the one that built the first one.
I was offered jobs in 38 states,
of course, because nobody
knew how to build a registry then.
[Louis Marchiafava] What finally led you to accept his offer?
(crosstalk)
[Eleanor MacDonald] Painless persistence.
I was in a speaking phase
and no matter how small a meeting
Dr. Clark would be there
extolling the grand juror of Texas.
He just wore me down that's all.
I hadn't any intention of coming to Texas.
I'm very family-oriented and we're all musicians.
Now by this time they were all in
New York so that we all play different instruments.
My oldest brother was also,
an engineer, an architect, and a priest.
He was in charge of construction Brooklyn,
Long Island complete clarinet with Jimmy Dorsey.
The whole family was musical,
but only one of them stayed in music.
We all diverted to other things.
I was professional for four years.
That's the way it was.
I like to get up there.
Our family was very devoted for 20 years.
Every Christmas we spent a week together in Hartford.
[Louis Marchiafava] Dr. Lee must've offered you
a promising career here to bring you.
[Eleanor MacDonald] Yes, he did. He's asked me to be
an Executive Assistant to him in the planning,
which I was until 1957.
Then I was terribly excited about this,
what was possible here.
He said with sunshine and
enough money and adequate facilities
and the best brains we'll solve this in Texas.
Here I'd spent on the nitty-gritty,
I'm putting the first how many cases
of how accurate were the death records.
I spent on this (inaudible) just checking and
checking in Massachusetts for 10 years and Connecticut.
It sounds like perhaps the answer.
All of us that came here felt that way.
He was a very inspirational leader.
[Louis Marchiafava] Can you tell me something about
his personality and his professional (crosstalk)?
[Eleanor MacDonald] If I tell you about this,
you couldn't understand that I guess.
Just in the meeting that day,
he heard something he thought would be good for Texas.
He thought I'd be good for Texas.
All stops were out from then on.
He came to my office.
He was there before I was there the next morning.
I gave him all these cards.
The night of the meeting,
he called me about midnight.
The meeting lasted forever
with the Board of Regions. I brought it up.
I took another course for five years,
what this story was interesting enough
to change the main but I wrote it up.
He called me, and said, "You'll never,
ever guess what happened."
I said, "What happened?" He said,
"When I got there they said no,
Dr. Clark is going
to talk about the plans for a new cancer program."
The man said, "I'm especially
interested because I come from
D Smith Company and
my grandfather died of cancer of the tongue.
What are my chances of having it?"
Talk about deja vu,
he pulled up the first thing I showed
him and he told them they
all gather around the table and all of
them had a relative or a friend from different counties.
From that time it started at
10 o'clock in the morning until six at night,
they were all asking different things.
Nobody asked about these programs.
They wouldn't do. They never do.
In some specific thing about cancer, they wouldn't do.
At six o'clock, the head of the Board of Regions said,
"Well, we have what we need here.
This is the best presentation of
a new program we've ever had."
Clark was sitting still,
he hadn't even pulled his plan for
a new program (laughing) from his pocket.
[Louis Marchiafava] Did he have one?
[Eleanor MacDonald] Yes, he had one. But it wouldn't have worked
because there are things about it that had to be changed.
But from the top of his head,
he wrote what he thought it ought to be.
It was a good plan,
but it missed things that he would
have known if he'd been in a public health field before.
You have certain bows to politics you have
to make in order to get your work
done in this field, in any field.
Anyway, he was quite delighted with it.
Then this thing in '46,
you see this was published.
This in '47 I met him.
He knew, by that time my name was quite famous.
This report didn't have my name on it. Isn't that funny?
[Louis Marchiafava] Yeah.
[Eleanor MacDonald] It didn't bother me a bit at the time.
Peron put it and George Smith was somebody he neglected.
The only name that appeared on
the foot of one of the pages
was quick
acknowledged the assistance of Frances McDonald.
That's the assistant you haven't heard of yet.
All forces went to medicine.
Frances was in the gynecology and obstetrics at Cornell.
For her life work and then Mary, eventually,
was the assistant professor
or associate professor of
neurology at the medical school here.
But she had been 10 years in charge of
Memorial when I put
her there when I came down
here and just think of what we had.
I had a 200-item code I called the anticipatory code.
Every question they ever wanted,
everything I could think of was in this code.
I worked for the doctors at
the Memorial to be sure it was on the record.
They let me correct their records to make sure it was on
them so they could fill it
in while the patient was still there.
We had these wonderful records
on punch cards in Connecticut.
I did them. They didn't have the equipment at Memorial.
I used to take them home with me,
bring them back and they'll do
the tables on my equipment in Connecticut.
Then Dr. Clark, of course,
said we have the IBM equipment
and we did before I got here.
The decision was finally made. I don't know.
I didn't want to go to New York.
Met my sister Mary did.
She is a musician.
She wanted to go there.
All the family was there.
But I didn't want to live in New York.
I have a headache all the time I'm there.
There's something about the pollution that just
bothered me and wasn't worth at
the feel punk all the time you were there.
If I just went for a weekend and I could get over.
[Louis Marchiafava] Well, in '47,
the facilities (noise) here at
Anderson were rudimentary.
[Eleanor MacDonald] We had barracks
buildings (crosstalk).
First I was in the library at the old Baker Estate.
The first day I was there,
Dr. Clark said, "Wait I want to see you.
I have an appointment." He was up in the master bedroom,
which was the principal, his office.
I guess he must have forgotten about
me because I had my own car with me
and it's the first time
I ever heard this verb used this way.
He came down around eight o'clock.
He said, "I didn't mean to do you this way."
They use that in Texas a lot.
I, of course in Massachusetts,
(laughing) was saying that,
and there's a song that came up in the mid '30s.
How come you do me like you do?
(music playing) We thought that was hilariously funny,
but they talk this way in Texas.
When he said it that night he's so funny.
(laughing) He had other expressions that are very
Texan and mispronunciations of words.
(noise) He was always raising people's horizons.
He never gave his speech and instead of horizon,
(noise) he would say we had to raise their horizons.
I think the people told him
dozens of times. He never picked it up.
He had certain words that he always mispronounced but
he had a very enduring personality in Texas overall.
He would do anything to get you here
and sometimes with things that weren't
very nice to get you like
promise you a certain salary
and not have it when you got here.
That happened to all of us.
[Louis Marchiafava] That happened to you too?
[Eleanor MacDonald] Yes.
[Louis Marchiafava] (crosstalk) You didn't get
the salary you were promised?
[Eleanor MacDonald] No. I could understand
because Texas only paid
12,000 and you had to get the
other money someplace else.
He couldn't very well ask for all the doctors
at 12,000 pay me the same as what you promised me.
But Hayes Martin took me to
the top of all the buildings.
There's a lot of stories.
I love that.
I helped get that money from (inaudible) (laughing) that
built the (inaudible) UN hospital up there.
One of the worst days my life.
But anyway, he took
me to the top of building and he said,
"If you come here, all of this would be yours."
I thought (laughing) this is too biblical for me.
(laughing) Who was it that said that before?
(laughing) He told me he didn't know.
He wasn't up on the Bible I guess.
I thought everybody knew that.
But it struck me terribly funny
that he did it because any worse thing to say to me,
it couldn't be anything that would appeal to me less.
(laughing) But they offered me 15,000 at the Memorial.
I love Memorial, but I just also knew that
Mary didn't have much younger than I was.
She had to go to Kansas,
set up a program to get
administrative experience more
than she had at the clinic
and waiting in order
to get an administrative job at Memorial.
She did. She went out there and she set
up a registry in Kansas.
It's the only one in the United States that's considered
accurate because it's never
been touched by federal funds.
[Louis Marchiafava] What plans did Dr. Lee
have for you? (crosstalk)
[Eleanor MacDonald] I asked him what he wanted me to do.
He said evaluate us.
Of course, I know how to do that. Setting up these.
[Louis Marchiafava] Evaluate what now?
[Eleanor MacDonald] Evaluate us at the Anderson.
I said that's fine.
[Louis Marchiafava] The hospital itself?
[Eleanor MacDonald] No. I'll tell you
I can only describe it by what I had to do.
[Louis Marchiafava] Okay.
[Eleanor MacDonald] I said our material is
only as good as our records are complete.
You can't get anything from a record that's not on it.
The Memorial consented to having
all the heads of departments work with me
and then allow us to check
their records while the patients were
there to fill it in so they had what they wanted.
Dr. Clark set up the first two weeks.
All of us got here, the 1st of October.
Heads of departments, first one in
the whole world probably that
were hiring an epidemiologist.
Well, the first epidemiologist in any hospital.
I certainly wasn't even heard of in Cancer Hospital.
[Louis Marchiafava] Now, were you the head of the department?
[Eleanor MacDonald] Yes, from the beginning.
I was a full professor here from the beginning.
(laughing) I was an assistant and an associate professor
in five medical schools.
In 1965, I was offered
a full professorship at Harvard medical.
I wasn't able to take it because I was having
heart problems at the time and I knew I wouldn't survive.
Well, I put it into a new program.
Then I was miraculously cured of my heart condition.
Did you ever hear Padre Pio ?
[Louis Marchiafava] No.
[Eleanor MacDonald] He was canonized up for
canonization 1st of May and I'm one of his miracles.
[Louis Marchiafava] I'm glad to hear that. (crosstalk).
[Eleanor MacDonald] That's why I'm here.
[Louis Marchiafava] Yes.
[Eleanor MacDonald] Yeah. I didn't know they took
them so seriously,
but they sent somebody over to check
all the records and records at the Anderson.
I had a cardiac arrest in '54 from
anesthesia and so I was out for three days.
It left me with a very damaged ventricle.
Ventricular tachycardia, 200 beats a minute,
by the hour, every day.
Finally, when I had one for 24 hours,
I didn't care whether I lived or not.
That was the day I was giving my
presentation at Harvard.
We had to speak to the whole staff.
I would go up 20 pounds in a day from
lack of oxygen, not very pleasant.
Then Padre Pio prayed for me and stopped it.
They couldn't believe. They got
all these records at the ends.
They get me to think I was cute.
They looked at that.
Look just like a baby's.
They would be going like this for years, the EKG.
By the way, I shouldn't put this on the scene.
[Louis Marchiafava] Usually, that's some of
the better material when people tell me that.
Why don't you put it on?
[Eleanor MacDonald] You know when your little girl's
five everybody said, isn't she cute?
When you're 90 you say the same thing. (laughing)
[Louis Marchiafava] Well, how did you structure your department
and who did you have working under you?
[Eleanor MacDonald] Well, I had eventually very quickly,
I had 35 people.
I had a big department with field workers, soldiers.
But what we did and reason that way we started was
(background) Dr. Clark had
every hit play with
how all Gilbert Fletcher and Bill Russell.
The first four heads of
the major departments took the first two weeks they were
there and I explained how to
have a complete record for them.
I got their consent to let me
check their records and make sure everything was there.
I had this 200-item anticipatory code.
It had all kinds of detail.
I worked it out at Memorial and they
used it there and then Mary carried it along.
If you picture a doctor is going to make a study,
he has to get the age and
the sex and you have to group and all that stuff.
They say take it down. It takes
some weeks to get that material.
My idea was to make that as fast.
They have other work to do but that could be handled
mechanically if we had
a cooperation of them to make
sure the information was correct.
They have appointed somebody
in the Department of Pathology.
We had access to him anytime to make
sure we recorded the past reports
correctly and we had access to
the surgeons to see
if every operation is a little bit different.
You could find out the number of
unilateral nodes that were taken out or bilateral.
You could find all this by my code,
but it was complex and we had counting sorting machines.
You'd have a wired board.
Dude, are you following this?
I must have had 200 layered boards.
You could put one in right after the other or after
same set of double punch cards, multiple punch cards.
Then you could practically compute another thing.
It was really wonderful.
I had one girl my
office that when computers came in at her own expense,
she went and learned how to program.
The enthusiasm was wonderful in my staff.
I very really had an antibody in the crowd.
If I did as they went,
they might be the most brilliant person,
but they had to get along with the group because we
had a stone deaf girl
that was so marvelous in record offices,
because she never got in any trouble.
(laughing) She never gossiped.
(laughing) She never heard anything was going on.
(laughing) She did at Methodist Hospital,
which would have been a sore point in the office.
(laughing) Twenty nine thousand records were out of order
from 44 to 64 in the Methodist Hospital.
They kept getting new record librarians without
enough personnel to correct the old mistakes.
Weekends, and I worked with them.
We ordered all the records in
that hospital and got them to place.
Eventually, 56 counties in Texas, every case,
every record and we re-ordered records in
Del Rio they had a hospital where
the record librarian gave
everybody that came in on the same day,
the same number, and they lost accreditation.
My workers never even called
me up when they discovered that.
They took all the records out,
an ordered them by movement of admission and
renumbered all the records for 15 years.
If you have know how to do
it and they're working in a team,
our sentiment appears,
that really worked very well
and I was fired and they were fired.
Dr. Clark used to call us the
whole office of boss ladies,
that anytime he had a late visitor and they wanted to
hear about the evidence and they
send them down to our office.
(laughing) Came one day and
one assistant epidemiology is a feisty little Irish.
They asked her what she did.
(laughing) (inaudible) everything.
We wrote the annual report.
I wrote the annual report till 1939-1960.
Maybe after but all people
would send me the material and I'd put it together.
Some of them relax,
and they hadn't even done the
dictate what they were doing.
The head of research was very relaxed.
He's a very good talker and
I haven't been good lecture to
the class and we've recorded
with the writers in the report.
I wanted to get them to Dr. Clark,
so they did the publishing on the first of
the fiscal year and you could
drag it along for several months if you waited,
so we didn't wait.
We had a system for getting it out.
I don't know how to tell you all this other stuff.
[Marchiafava Louis] Well, I'll drive your (inaudible)
[Eleanor MacDonald] Ask me the question.
[Marchiafava Louis] Yeah.
Chronologically speaking now,
what are some of the advances or major changes
that occurred in your department under your leadership?
[Eleanor MacDonald] All of the problems of the departure.
Every single clinical study
at the time I was there, went over my desk,
though they didn't have to
but after they tried to handle the data,
they found they got so much help from us,
which you see if I have
two major items already coded on every record,
with the follow-up kept up-to-date,
so if they had one idea about cancer of
the tongue or (inaudible),
they could work on that one idea
and they come into my office,
and I had eight or 10 people trained to
do this special study code.
I worked with every one of these myself,
and then I said,
what do you want to know?
We'll run off 50 or 60 records
to see if you get what you want
because sometimes they think they want
something and it doesn't mean when you code it,
that isn't what they wanted.
We'll run off (inaudible) with
a preliminary code of what different items that
were not on our big things on the regular records.
I can show you some of these code trials after a while,
it may make it easier to understand.
[Marchiafava Louis] I have an idea because I've
seen some photographs, so (inaudible)
[Eleanor MacDonald] Well, there aren't as
complex as they look,
but if you do them right.
But we had one check,
everyone else was double-checked.
Everyone coded and it was coded again by
somebody else to make sure that it was correct,
so they were correct.
The deck of records of cards that
I left there when I stepped out of my department,
I would be proud of because they were complete.
I had a surgical index,
I had a metastatic index.
Every metastatic lesion, it might be 10 or 1 person.
Having been located within the period
of time when they came in.
I started that, that was
(inaudible) but to start at the beginning,
they just do it automatically and then
suddenly you have the material.
My successor threw that file away,
threw that whole thing away.
Ready to go with the computer because he needed a file?
[Marchiafava Louis] Who was your successor? Who did this?
[Eleanor MacDonald] One man who got the job.
I remember he was a successor.
His name was Genet.
[Marchiafava Louis] Pardon, what?
[Eleanor MacDonald] Genet.
[Marchiafava Louis] How do you spell that?
[Eleanor MacDonald] I think it's G-E-N-E-T.
He had been fired for incompetence from
New York City Health Department
and a couple of other places.
[Marchiafava Louis] And he was hired?
[Eleanor MacDonald] I don't know how he was hired.
Several departments was destroyed in six months.
[Marchiafava Louis] What?
[Eleanor MacDonald] I was still there, watching it go.
Things happen. Crazy. I had a girl who was (crosstalk)
[Marchiafava Louis] What year was that? Excuse me.
I didn't get that.
[Eleanor MacDonald] '70. I stepped off my department in
'74 and then I had a grant till '82.
In '74, I was already (inaudible)
(laughing) in '76 I was 70 so I was 68.
But nobody mentioned that because
Clark and I are the same age.
Nobody mentioned his age.
Nobody mentioned mine but that pension thing,
he was too much younger than I was.
[Marchiafava Louis] Well, concerning the destruction of
these records or the disorganization.
[Eleanor MacDonald] I had the file for surgical index.
We had rented hospital beds the early days.
Nobody but me and Clark could talk to
the hospital association into
approving the hospital that didn't exist.
We were only beds in
certain hospitals and that was
very hard from a record point of view to keep track of.
I went to every one of them in
Xeroxed every surgical record that we had and
went to the doctors who were still there
and coded exactly what the operation was.
With that, everyone was okay by that.
An absolutely irreplaceable record source
and we have what I call visible punch cards.
We type the main thing down so that if I wasn't there,
the doctors could go to the file and get it.
They could see it themselves and that was a double help.
When you start small and you can do that.
We had every one from record one in
there and this man had them all thrown out one day.
[Marchiafava Louis] What justification?
[Eleanor MacDonald] He needed the file.
[Marchiafava Louis] I'm sorry?
[Eleanor MacDonald] He needed the file.
I went in until one day,
he came in and I said everybody is ready for you.
I knew about him and I was
absolutely destroyed that he was going to be there
because of a long series of failures in his past.
I said to him they're all ready for you and we have
(inaudible) randomization schemes for
all departments and that's what that means.
It means that we would make a plan with
a doctor for randomizing
study so we'd have a real good sample.
Then if they, like Bupa Fletcher,
say, he had stage 1, 2,
3, cancer of the cervix,
he'll call up and say this is stage 2.
What shall we give them? In our place,
we never did experiment with the patients on something,
that wasn't known about Dr. Clark. First a clinician.
That was wonderful in that there's
no wild experimental things on
chemotherapeutic methods unless they were tried
out in laboratory animals and assured first.
There was none of that kind of past
experimenting while Clark was there.
I was always very proud of that.
[Marchiafava Louis] Did you report what was
going on to Clark?
What was going on with the destruction of these records?
[Eleanor MacDonald] No, there was no access for that time.
It was done before you knew it.
(inaudible) was my top assistant,
was working for somebody else
and Cox was still over there.
[Marchiafava Louis] What was his last name?
[Eleanor MacDonald] Cox. I forget his first name.
He's a radiologist.
He wanted to know how many bilateral
and unilateral nectar sections had been done.
She went to get it, the file was destroyed.
Where is it? What files?
This file. I needed a file and threw it out.
They raised $250,000 in
Department of Surgery to try to
reconstruct this file but they only went back five years.
We went back to 40 for every record.
I was sick for a week later that I couldn't believe it.
[Marchiafava Louis] Was he fired?
[Eleanor MacDonald] No, of course not. He had tenure.
Tenure came in the year he came in.
Nobody knew what to do with him
but he shouldn't be pulling off
all of these from records.
[Marchiafava Louis] No. The committee said
they want the story as it is, the truth.
[Eleanor MacDonald] Well, first day I went to
him and told him that
my department which I was
tenderly handing over to
him and they were all ready to help him, (inaudible)
[Marchiafava Louis] Tape over.