And our next paper will be a discussion of Louise Eisenhardt's personal notes, how she and Dr. C collected data and followed patients, to be presented by Dr. Hundley. My name is Kelsey Hundley. I'm a resident at the University of Arkansas. Thank you to the AANS for inviting me to present this work, and thank you, Dr. Pate, for your patience and encouragement. Briefly, Louise Eisenhardt was born in 1981 in Ramsey, New Jersey. She is revered for her commitment to the advancement of neurosurgery and neuropathology. She was the first editor of the Journal of Neurosurgery, and until this year, she was the first woman who served as president of the AANS, then known as the Harvey Cushing Society, in 1938. Her long list of accomplishments and singular devotion to excellence makes her a pillar of our specialty, and one of the most compelling characters in its history. But specifically today, I want to talk about and highlight her ingenuity and tenacity in the way she collected data by presenting her personal notes on the matter. I have no disclosures. Dr. Eisenhardt began working with Harvey Cushing as a secretary in 1915 at the Brigham in Boston. When he left for the war in 1917, he left her with the arduous task of indexing and eventually publishing tumors of the nervous acousticus. She started keeping records of his tumors in 1922 in her famous Little Black Book, and she went to Tufts Medical School. She graduated in 1925. When she finished, after a brief internship, she rejoined Dr. Cushing at the Brigham, where they continued their work on the classification of tumors. It only seemed natural when he retired from the Brigham in 1932 that she would join him at Yale to continue their work, and what would eventually go on to become their monograph on meningiomas. But how did she do it? The senior author on this paper found Dr. Eisenhardt's handwritten notes at the bottom of a box given to him by Dr. Flanagan. In them, she describes her unusual and creative and now many illegal ways as they went about collecting this data and follow-up on their tumor patients. This is the first page of her notes, titled Life Expectancy. With 2,000 identified tumors and 700 patients living, she writes, life is not so hopeless for those affected with intracranial tumors as is generally supposed. In her notes, she divides their methodology into early follow-up and registry follow-up, or rather the methods they began using once their registry was founded at Yale. In the early follow-up, data collecting was very typical. They sent letters to their patients two years after discharge and asked them to write back on the anniversary of their operation. And specifically for their acoustic neuromas and their meningiomas, stereotyped letters were sent home with stamped addressed return envelopes enclosed. And when the registry was founded, they had to come up with unique ways to get in contact with patients with whom follow-up had been lost, sometimes 15 to 20 years prior. And she writes, this meant considerable effort on our part. This was an understatement. Now, some patients, like Dr. Eisenhardt, were very meticulous in their self-reported follow-up, writing letters year after year. Other patients, more like me, sent back dirty, worn envelopes with reports that were years overdue. And some, due to difficulty with language, were unable to write back at all. I can't imagine in the 1930s and 1940s, before Google and geotagging and Facebook Live and Instagram Stories, what an interesting feat it must have been to get in contact with these people. Some moved. They left the country. They got married and changed their names. And in one case she describes, someone changed their name and did not get married. She writes, we used every possible clue to be jumped upon in our clinical research in correspondence. They started very simply, family, friends, neighbors, physicians who had once treated the patients, employees, former employees. Obviously, this was all well before HIPAA. In some instances, they found the postman who was bringing their original correspondence to patients and asked him to go to the neighbor's house and get reconnaissance information on where these people may have gone. All of this in an effort to document follow-up on their patients. It was routine for them to go to City Hall, go through old records, go through voting records, go through tax records. They searched through the Bureau of Vital Statistics, hometown newspapers. They went to the Bureau of Education if the patient was a teacher. They even searched through people's insurance policies. And that actually turned out to be quite fruitful because so many of their patients had applied for disability insurance. They went to churches. And in one instance, they convinced the mayor of a town to get the priest whose housekeeper was the sister of a patient who had changed his name to get his exact date of death. In other instances, routine methods were not enough, and they had to use what she called strong arm methods. The Board of Education invited them or sent them to a teacher's house, but the teacher refused to let Harvey Cushing in her door. And so Louise Eisenhardt sent the Fuller Brushman, the once ubiquitous door-to-door selling brush cleaner, who, by the way, still has late night, early morning ads running on television. Please don't ask me how I know that. Sent the Fuller Brushman to her house to gain access to her. She did let the Fuller Brushman in to see if she actually did have a reported residual deficit after surgery. And once, they even got permission from a family via long-distance telephone call to exhume a body to examine it. Through their diligence, not only did they obtain simple data, they formed deeply personal relationships with their patients over many years. Patients would come from afar to see them in clinic. They would call long distance on the telephone to tell them how they were doing. She writes that if there was any indication of a possible recurrence, we have no stone unturned to see the best possible care is given. And given the lengths they went to just to obtain data, I believe that this must be true. It was once a strongly held belief that an intracranial tumor was a death sentence, but their diligent work showed us just the opposite. Life is not so hopeless. At our library at UAMS, there are many neurosurgery greats hanging on the wall. And above them, all of them, is this one of Louise Eisenhardt looking down on us. Thank you. Applause Thank you very much.

Louise Eisenhardt

tumor patients

neurosurgery

data collection

intracranial tumors