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Speaker 1: Welcome to Stuff You Missed in History Class, a production

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Speaker 1: of iHeartRadio. Hello and happy Friday. I'm Holly Frey. And

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Speaker 1: I'm Tracy B. Wilson. And we talked about Philippe Pinel

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Speaker 1: this week. Yeah, not a name I had heard of,

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Speaker 1: I don't think. I am very intrigued by his whole story.

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Speaker 1: I mean, I like medical history in general. I like

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Speaker 1: psychiatry and psychology history a lot, as you may have

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Speaker 1: guessed from things I have selected in the past. And

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Speaker 1: I find his story especially intriguing because it does represent

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Speaker 1: somebody who is so forward-thinking in the field, but is

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Speaker 1: also kind of tripping over their own feet. Kind of, yeah.

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Speaker 1: Forward-thinking in some ways, unlimited in other ways. Yeah. One

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Speaker 1: thing that we did not talk about until we got

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Speaker 1: to the point where we mentioned that he had a

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Speaker 1: son who also became a psychiatrist was his family, because

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Speaker 1: I did not find a lot of information about when

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Speaker 1: he got married, who he married. I know he had

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Speaker 1: a son, and I've seen a painting of him with

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Speaker 1: what appeared to be a son and daughter, but there's

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Speaker 1: no information regarding his daughter or his wife. So apologies.

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Speaker 1: If you are a scholar of Pinel and you know,

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Speaker 1: let me know. We similarly did not mention Ashurbanipal's wife

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Speaker 1: or children other than the two sons. I just didn't

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Speaker 1: find a ton of... It can be... no family information time. Yeah,

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Speaker 1: sometimes those people get documented, and sometimes they don't. I

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Speaker 1: mentioned when we were talking about the quote that we

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Speaker 1: read about him saying, like, some people will tell you

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Speaker 1: that brain lesions are the cause of mental issues, but

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Speaker 1: I'm telling you no. And he's obviously super wrong. We

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Speaker 1: know that that can be the case. I really feel

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Speaker 1: like at that point... he had started to believe that

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Speaker 1: he could potentially cure anyone. And so to admit, and again,

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Speaker 1: this is my theory, no basis in anything I read.

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Speaker 1: But I think to admit that like, oh no, it's

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Speaker 1: something physical that can't actually be helped would have messed

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Speaker 1: up his whole sense of purpose in what he was doing. Yeah,

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Speaker 1: that makes sense. That's just my guess. But based on

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Speaker 1: the way he writes about people and treatments that he did,

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Speaker 1: I really feel like that's probably the heart of why

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Speaker 1: he was so dismissive of the physical science of it.

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Speaker 1: He also did an interesting thing and is, to the

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Speaker 1: best of my knowledge, the first person to ever approach

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Speaker 1: it this way. One of the things we didn't talk

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Speaker 1: about a lot were all the ways he classified his

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Speaker 1: mental alienation groups. But one thing that he wrote a

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Speaker 1: good bit about was the difference between people who are

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Speaker 1: always in a state of mental alienation versus people who

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Speaker 1: have episodes and other times they are in their normal,

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Speaker 1: for lack of better phrasing, right mind, right? And he

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Speaker 1: started developing this way of treating them and working with

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Speaker 1: those patients where when they were not in an episode,

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Speaker 1: he would discuss their case with them very transparently and

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Speaker 1: be like, how do you think we, you and I together,

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Speaker 1: can address this person you become when That crops up

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Speaker 1: and how can we help this move your treatment forward,

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Speaker 1: which is just an interesting idea. Uh-huh. Again, he needed

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Speaker 1: more science backing up all his stuff. Yeah. But I

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Speaker 1: am sort of, I don't know if impressed is not

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Speaker 1: the word, but it is quite striking the way that

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Speaker 1: he always saw his patients as from a very human

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Speaker 1: lens and never was like... Uh-huh. in the parlance that

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Speaker 1: was often used, they're at this point animals, I can't

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Speaker 1: deal with them. He always knew that there was somebody

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Speaker 1: in there that he just needed to get to, which

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Speaker 1: I really appreciate and find the most hopeful about his

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Speaker 1: writing and his work. Yeah, he's just an interesting guy.

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Speaker 1: Interesting dude. I love that he was like, are we

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Speaker 1: not doing baths? This is the easiest. Right. Hey, look,

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Speaker 1: people aren't dying of stupid things anymore because they're clean. Yeah.

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Speaker 1: A lot of that, maybe not to the extent of

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Speaker 1: literally not having a bath for the patients. But, like,

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Speaker 1: a lot of that is... These are still things that

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Speaker 1: are issues in institutions today. For sure. Like, my mom's

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Speaker 1: career for a long time was long-term care for disabled children,

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Speaker 1: and they were all children who had multiple complex disabilities. Right.

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Speaker 1: Extremely high support needs. And... my mom one time did

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Speaker 1: like a training video for the staff that was basically

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Speaker 1: about things like, yes, we don't know if this child

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Speaker 1: is self-aware. They still deserve privacy. Like when going to

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Speaker 1: the bathroom, that kind of stuff. Like, reinforcing the, like,

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Speaker 1: these are, we're, these are all, these children are all

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Speaker 1: people and they all have the same right to dignity

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Speaker 1: and respect. Yeah. Even when we are not sure whether

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Speaker 1: we are able to communicate with them or them with us. Yeah. So, yeah. Yeah,

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Speaker 1: it is, it's really interesting in that, like, both of

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Speaker 1: those are just you know, both like the work your

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Speaker 1: mom was doing, the stuff Pinel was doing, it's all

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Speaker 1: really rooted in just kindness and respect, which it's kind

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Speaker 1: of funny when you kind of break it down to

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Speaker 1: that level of simplicity to be like, and that was

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Speaker 1: very forward thinking. It's very disheartening. I'm not laughing because

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Speaker 1: it's funny. I'm laughing because it sounds so absurd. Yeah.

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Speaker 1: But has been a problem with humans for a long time. Yeah.

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Speaker 1: Reading papers about him because there's a lot of scholarship

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Speaker 1: about him. I feel like he's one of the go-tos

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Speaker 1: that people do when they're doing like a PhD or

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Speaker 1: something because I found so many papers. There is often

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Speaker 1: a very bifurcated path. Like people are either like, this

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Speaker 1: guy was great. He's why we're doing a lot of

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Speaker 1: what we do today. Or what a train wreck. I

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Speaker 1: can't believe he just accidentally stumbled on some stuff. that

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Speaker 1: moved things forward, but he was doing it all wrong.

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Speaker 1: And of course, then you have the Foucault of it all,

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Speaker 1: which I can't even. I felt like I needed to

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Speaker 1: mention that because it gets brought up in almost everything

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Speaker 1: you read about him, about Pinel, that like Foucault really

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Speaker 1: hated Pinel's ideas. And I'm like, yeah, but did you

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Speaker 1: read that Foucault stuff? Because he just wanted people to

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Speaker 1: be allowed to go untreated and not ever address any problems.

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Speaker 1: And like to him, imposing treatment on people was taking

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Speaker 1: away personal choice. Which I could see in certain instances,

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Speaker 1: but if someone is dangerous, that's not really an option.

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Speaker 1: Michelle Foucault, you had a lot of feelings and thoughts.

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Speaker 1: I think Foucault might like some of the TikTok influencers.

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Speaker 1: I think we just wrote a play. Yeah. I would

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Speaker 1: watch this play, Michelle Foucault dealing with the age of

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Speaker 1: social media and influencers. Yeah. Yeah. I feel like there's

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Speaker 1: something there. I've always wondered, like, if someone would do

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Speaker 1: a thing that's like, if Oscar Wilde had TikTok. Right. Wow.

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Speaker 1: Which I think I would watch nonstop. Yeah. I'd be like, damn,

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Speaker 1: he's really sassy and opinionated. And I don't agree with everything,

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Speaker 1: but I can't stop looking. Although I do love me

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Speaker 1: some Oscar Wilde. We talked about Coley's toxins, one of

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Speaker 1: the earliest cancer immunotherapies. Some of the sources that I

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Speaker 1: looked at for this and their timelines of cancer immunotherapy

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Speaker 1: started with ancient Egypt. Under the argument that in ancient Egypt...

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Speaker 1: one of the treatments for cancers involved sometimes cauterizing the

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Speaker 1: site of the cancer, sometimes making some kind of other, like,

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Speaker 1: attempt at removing the cancer, and then dressing this area

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Speaker 1: with bandages and poultices and stuff. And it seemed like

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Speaker 1: the argument was they probably would have gotten an infection

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Speaker 1: from that, and the infection... might have then prompted the

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Speaker 1: body to also attack the cancer. And I felt like

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Speaker 1: that was a reach. I mean, yeah, I'm sitting here

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Speaker 1: and I'm like, I mean, I see where you could

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Speaker 1: land there, but it does seem like an awfully long walk.

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Speaker 1: It was a long walk to me. Also, when I

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Speaker 1: started on this, I was just imagining that it would

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Speaker 1: be a historical overview of the history of immunotherapy. And

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Speaker 1: that came about because I am pretty sure in addition

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Speaker 1: to this experience that I had watching the news at

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Speaker 1: my parents' house and going, cancer immunotherapy? I thought, did not.

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Speaker 1: Mary Robinette Kowal, who is an author and has been

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Speaker 1: a guest on our show, didn't she suggest a history

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Speaker 1: of immunotherapy as a topic one time? Then I went

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Speaker 1: through my notes and It's possible that she suggested that.

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Speaker 1: It's also possible that she suggested a history of IV

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Speaker 1: therapy because I have it written down each way. And

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Speaker 1: whatever that conversation was, it was long enough ago that

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Speaker 1: I no longer have the email or the social media

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Speaker 1: comment or exactly where it came from. Either way, though,

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Speaker 1: was one of the things that kind of combined together

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Speaker 1: to make me think this would be a fun thing

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Speaker 1: to do. Maybe not fun, but like this would be

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Speaker 1: an interesting thing to do for the show. So I

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Speaker 1: started out collecting information for a historical overview of cancer immunotherapy.

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Speaker 1: And as I got into the more modern decades, starting with, say,

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Speaker 1: the 70s and the 80s, every next step in the

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Speaker 1: possible timeline... was an entirely new immune system concept to

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Speaker 1: need to understand and explain. Oh, yeah. And I just kept,

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Speaker 1: I was just writing all of them down. So-and-so discovered

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Speaker 1: blah-de-blah in whatever, in, like, 1997, and thinking, I'm going

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Speaker 1: to have to go back to this and, like, figure

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Speaker 1: out how to explain this thing, the blah-de-blah that was discovered.

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Speaker 1: And also, I was dealing with a mild respiratory illness

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Speaker 1: at this time that was not the end of the world,

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Speaker 1: but was making it harder to cope. think and concentrate.

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Speaker 1: And I realized two things simultaneously. One was that I

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Speaker 1: had way too many notes for a one-part episode, and

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Speaker 1: a one-part episode was what was feasible to do at

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Speaker 1: this moment in our calendar and in our lives. And

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Speaker 1: then number two, there was no possible way I was

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Speaker 1: going to understand all of these things. And then also

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Speaker 1: that Coley's toxins seemed like a whole topic all by

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Speaker 1: themselves that I found very interesting and that I found

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Speaker 1: much more able to reasonably explain. So when I went

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Speaker 1: through and then started writing the actual outline from my notes,

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Speaker 1: I had a tiny little overview of what immunotherapy means.

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Speaker 1: I had some other stuff about that that got deleted,

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Speaker 1: got into Coley's story, got to the end of Coley's life,

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Speaker 1: got to why we don't really use these as a

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Speaker 1: treatment in the And then I had, I think, four

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Speaker 1: pages of subsequent timeline notes that I just deleted. No,

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Speaker 1: you saved those for later. I did not save them

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Speaker 1: for later. I think I would have saved them for

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Speaker 1: later had I not been ill and maybe not thinking

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Speaker 1: as clearly as normal. Also, those many years of timeline,

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Speaker 1: things that came after the death of Coley are pretty

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Speaker 1: easy to reconstruct. Should I at some point decide to

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Speaker 1: revisit the idea of like an overview, historical overview of immunotherapy?

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Speaker 1: I do have a question. Do it. Because you specified

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Speaker 1: in this outline and in what you just said that

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Speaker 1: they're not used in the U.S. Are there places where

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Speaker 1: people are using them? Yes, it seems like yes. And

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Speaker 1: it seems like the places where they are used are

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Speaker 1: places where maybe the pharmaceutical and medical system is not

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Speaker 1: quite as regulated or perhaps... there is a broader set

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Speaker 1: of exceptions to the general rules for people who have

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Speaker 1: things that seem to be not responding to other treatments.

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Speaker 1: As far as I know, there's not like a... big

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Speaker 1: pseudoscience focus on these toxins as a, like... Which is

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Speaker 1: surprising to me. Yeah. But I also felt like the

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Speaker 1: way it was discussed in some of the more official, like,

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Speaker 1: cancer research... cancer awareness bodies did seem like it was

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Speaker 1: the thing that everyone acknowledged that like people could glom

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Speaker 1: on to this as a pseudoscience. If they just needed

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Speaker 1: something to do. But again, it's like there are newer,

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Speaker 1: more effective, more specific, more conclusively demonstrated treatments at this point.

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Speaker 1: And even when he was, you know, publishing his work,

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Speaker 1: the fact that he had what appeared to be approximately

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Speaker 1: a 10% cure rate, that's not a huge percentage. But

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Speaker 1: the alternative for a lot of the cancers that he

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Speaker 1: was working with was, like, amputate this limb and hope.

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Speaker 1: And that's not a lot. And there are, for a

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Speaker 1: lot of the cancers that he was working with, other

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Speaker 1: options today. I'm just surprised because it does seem like

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Speaker 1: the kind of thing that some people would get very

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Speaker 1: obsessed with under the claims of a natural cure. Don't

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Speaker 1: do that. A natural cure of bacterial toxins. It's one

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Speaker 1: of those things that it's like, it seems like when

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Speaker 1: it did work for people, it seemed miraculous and gave

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Speaker 1: people years of life that they probably would not have

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Speaker 1: had otherwise. Yeah. But also just did not work at

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Speaker 1: all for some people. One of the things that makes

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Speaker 1: further study of them more difficult is today we have

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Speaker 1: this thing called GMP rules, which are good manufacturing practices.

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Speaker 1: and developing things that follow those rules when you are

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Speaker 1: making pharmaceuticals and other substances, it can be very expensive

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Speaker 1: and very difficult. And it was already difficult and expensive

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Speaker 1: to make these toxins. And when there are other things

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Speaker 1: that are being developed and being explored that seem more

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Speaker 1: consistently promising in some ways, that does not leave a

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Speaker 1: lot of reason to sink lots and lots of money

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Speaker 1: to something that is going to be So expensive. Right.

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Speaker 1: That may or may not work. A couple of side notes.

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Speaker 1: We mentioned that Coley worked at three different hospitals. He

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Speaker 1: was on staff at all three of them at the

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Speaker 1: same time. Not for his whole career, I don't think,

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Speaker 1: which seemed to be a normal thing. He was working

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Speaker 1: with a lot of the same surgeons at multiple different hospitals.

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Speaker 1: And it's today, I think, I'm not a surgeon. I

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Speaker 1: don't think I even know any surgeons. I do know

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Speaker 1: some people who work in the medical field. You don't

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Speaker 1: have a secret surgery career? I don't know about that. No,

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Speaker 1: that'd be weird. I think it is common for, like,

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Speaker 1: surgeons to have privileges at multiple hospitals to be able

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Speaker 1: to conduct surgeries there, but it seems like he was

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Speaker 1: considered a staff member at multiple hospitals, which I think

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Speaker 1: that might not be quite as common today. If you're

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Speaker 1: a surgeon and you know that not to be true,

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Speaker 1: feel free to explain how your profession works. I feel

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Speaker 1: like we're having an accidental theme in things that we're

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Speaker 1: recording today. about people stacking their careers. Oh, sure. Multiple

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Speaker 1: jobs at once. So Coley and Dr. William T. Bull,

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Speaker 1: who Bull had been the original doctor of this patient

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Speaker 1: that he had tracked down, they both worked together at

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Speaker 1: the hospital that came to be known as the Hospital

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Speaker 1: for Special Surgery, in addition to their work at New

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Speaker 1: York Hospital where this thing happened. And I think also

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Speaker 1: at the cancer hospital. At the hospital for special surgery,

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Speaker 1: the two of them developed new surgical techniques for treating

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Speaker 1: hernias in children. Very cool. Like, replacing techniques that, as

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Speaker 1: I understood it, basically didn't work for most kids. They

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Speaker 1: developed a whole new approach to do it that made

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Speaker 1: it possible to treat hernias in children that had previously

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Speaker 1: not been treatable. That's amazing. So, yeah, this was, like,

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Speaker 1: not a biography of Coley. It was only focused on

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Speaker 1: his work with his toxins. But, like, he did have

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Speaker 1: other things in his surgical career besides that. Counterpoint is

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Speaker 1: not the exact word, but, like, on a sadder note,

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Speaker 1: it seems like his treatment of Bessie Daschle when he

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Speaker 1: was trying to figure out what was going on with her,

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Speaker 1: that might have made it worse. Oh, gotcha. So he

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Speaker 1: was a brand new... like, just a few months on

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Speaker 1: the job as, like, having finished his internship, brand new

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Speaker 1: as a surgeon, operating on his own. He did not

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Speaker 1: have any reason to think that this 17-year-old had bone cancer.

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Speaker 1: So his way of basically looking in her hand to

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Speaker 1: see what was going on seems like it probably broke

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Speaker 1: some of the tumor into parts that then circulated through

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Speaker 1: her body and seeded tumors elsewhere. Which he didn't have

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Speaker 1: a huge reason to have thought that that would even

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Speaker 1: be an option, because why would a 17-year-old have had

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Speaker 1: bone cancer? Right. And I don't think he even knew

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Speaker 1: that at the time, or even suspected it at the time.

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Speaker 1: But other people with medical knowledge that have written about

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Speaker 1: him have sort of said, like, that might have made

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Speaker 1: it worse. It kind of reminded me of, I don't

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Speaker 1: know if it's used anymore, but there was a treatment

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Speaker 1: for uterine fibroids that was basically sending a little drill

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Speaker 1: in there to kind of blast them up. Yeah. But

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Speaker 1: what if it actually is a tumor? Right. That could

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Speaker 1: be malignant? Like, that then just... Like, are you propagating it?

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Speaker 1: Propagates cancer cells. Right. Yeah. And then the last thing

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Speaker 1: that I had written on here was just like, there

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Speaker 1: was so much stuff I did not have to learn

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Speaker 1: and figure out how to explain once I narrowed down

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Speaker 1: this topic. Which I think trying to learn and explain

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Speaker 1: all of them would have been a really tall order,

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Speaker 1: even if I had not been somewhat unwell the whole

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Speaker 1: time I was working on it. Yeah. Here's the Murphy's

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Speaker 1: Law for me that always happens. in that scenario. Yeah.

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Speaker 1: When I'm like, this is going to be a hard one,

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Speaker 1: but I can do it. That's the week that, like,

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Speaker 1: everything explodes. Uh-huh. Where it's like, oh, and your refrigerator died.

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Speaker 1: And also, there's a, you know... mangled raccoon on your

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Speaker 1: deck that needs help. And also, these are things I'm

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Speaker 1: making up. These are not things I'm dealing with. But

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Speaker 1: it's always like, there's like a weird thing where the

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Speaker 1: universe goes, hey, you think you can handle that? Guess what? Yeah. Yeah.

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Speaker 1: I felt bad enough to take half a day off

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Speaker 1: partway through my illness, which I have not needed to

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Speaker 1: do in a while. I've been very blessedly not sick

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Speaker 1: in a while. So the fact that I then needed

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Speaker 1: a half day to lie around. Well, let's keep it

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Speaker 1: that way. Yeah. Knock on wood. Knock on wood. I

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Speaker 1: had just gotten back from some travel, and it's pretty

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Speaker 1: sure something that I picked up in transit. So, yeah. Yeah.

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Speaker 1: Do you have anything else that you would like to

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Speaker 1: say about Coley? No, because you said knock on wood,

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Speaker 1: and now Amy Stewart is singing in my head. Okay. Well...

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Speaker 1: Whatever is coming up on your weekend, I hope that

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Speaker 1: it goes as well as is possible, even better than expected,

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Speaker 1: better than you think is possible. That's what I hope.

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Speaker 1: I'm thinking back to the days when my days off

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Speaker 1: used to be on Tuesday and Wednesday every week, which

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Speaker 1: in some ways was kind of fun. Yeah. If you

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Speaker 1: have a Tuesday or Wednesday or other midweek time off,

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Speaker 1: or if you are in a place where you're needing

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Speaker 1: to have overlapping things and not a lot of time off,

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Speaker 1: then I hope you're able to take a little time

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Speaker 1: to have a moment for yourself. Do something that's a

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Speaker 1: little refreshing for yourself. treat yourself or maybe treat somebody

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Speaker 1: else or treat both of you everybody gets a little

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Speaker 1: treat we will be back with a brand new episode

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Speaker 1: on monday and of course we'll have a saturday classic

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Speaker 1: tomorrow stuff you missed in history class is a production

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Speaker 1: of iheart radio for more podcasts from iheart radio visit

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Speaker 1: to your favorite shows