1 00:00:01,080 --> 00:00:04,040 Speaker 1: Welcome to Stuff You Missed in History Class from how 2 00:00:04,080 --> 00:00:13,680 Speaker 1: Stuff Works dot com. Hello, and welcome to the podcast. 3 00:00:13,840 --> 00:00:17,640 Speaker 1: I'm Tracy V. Wilson and I'm Holly Frying. So we've 4 00:00:17,640 --> 00:00:19,600 Speaker 1: mentioned quite a number of times that we have an 5 00:00:19,600 --> 00:00:24,000 Speaker 1: extensively long list of two dudes on the podcast. There 6 00:00:24,000 --> 00:00:28,240 Speaker 1: are hundreds and hundreds and hundreds of listeners submitted suggestions, 7 00:00:28,320 --> 00:00:30,000 Speaker 1: and then we have our own to do lists, and 8 00:00:30,040 --> 00:00:34,400 Speaker 1: they're both very long and sometimes sort of like when 9 00:00:34,479 --> 00:00:37,800 Speaker 1: you're uh you have access to hundreds of channels on 10 00:00:37,840 --> 00:00:42,680 Speaker 1: the television, it just feels like nothing's on. I scrolled 11 00:00:42,720 --> 00:00:44,480 Speaker 1: through all those things, and there are so many great 12 00:00:44,479 --> 00:00:47,760 Speaker 1: ideas on there, but none of them are quite catching 13 00:00:47,880 --> 00:00:50,400 Speaker 1: my attention that day. And you and I both know 14 00:00:50,479 --> 00:00:52,680 Speaker 1: from experience that the best episodes come from when we're 15 00:00:52,680 --> 00:00:55,120 Speaker 1: really engaged with what we're talking about. Yeah, if you're 16 00:00:55,120 --> 00:00:56,720 Speaker 1: just not in the mood for a topic, even if 17 00:00:56,720 --> 00:00:58,760 Speaker 1: it's an awesome topic, it just won't turn out as 18 00:00:58,800 --> 00:01:00,240 Speaker 1: well as if you wait a little while all and 19 00:01:00,320 --> 00:01:03,080 Speaker 1: let it become the thing that catches your mood. Right, 20 00:01:03,320 --> 00:01:04,680 Speaker 1: And some of the things I was in the mood 21 00:01:04,680 --> 00:01:07,920 Speaker 1: to talk about, we're on hold until uh Stuff could 22 00:01:07,959 --> 00:01:11,360 Speaker 1: come in from the library. So I was browsing around 23 00:01:11,360 --> 00:01:15,840 Speaker 1: the Internet and found a post on Rejected Princesses about 24 00:01:16,080 --> 00:01:19,600 Speaker 1: Dr Vera Peters, who was one of the foremost oncologists 25 00:01:19,640 --> 00:01:22,640 Speaker 1: in the world in her time. Not only was she 26 00:01:22,720 --> 00:01:25,600 Speaker 1: one of the only female oncologists in the world, she 27 00:01:25,680 --> 00:01:29,280 Speaker 1: completely changed the standard of care for two different types 28 00:01:29,319 --> 00:01:33,160 Speaker 1: of cancer. And she was one of rejected Princesses modern worthies, 29 00:01:33,200 --> 00:01:34,960 Speaker 1: and those are usually about a woman who died within 30 00:01:34,959 --> 00:01:38,960 Speaker 1: the last fifty years. The Rejected Princesses Modern Worthies posts 31 00:01:39,000 --> 00:01:41,200 Speaker 1: tend to be pretty brief, so this one hits the highlights. 32 00:01:41,640 --> 00:01:45,200 Speaker 1: Dr Peters helped revolutionize the treatment of both breast cancer 33 00:01:45,280 --> 00:01:47,720 Speaker 1: and Hodgkins lymphoma, but at the time that she did, 34 00:01:47,760 --> 00:01:51,560 Speaker 1: her work was largely ignored and dismissed. So naturally immediately 35 00:01:51,600 --> 00:01:53,639 Speaker 1: I wanted to know a lot more about this person 36 00:01:53,680 --> 00:01:56,560 Speaker 1: and what she did. Therefore, we're gonna have a whole 37 00:01:56,560 --> 00:02:00,960 Speaker 1: episode on her today. Hooray, will do the usual set 38 00:02:01,040 --> 00:02:06,360 Speaker 1: up on early life. Mildred Vera Peters was born in Rexdale, Ontario, 39 00:02:06,560 --> 00:02:10,400 Speaker 1: on April nineteen eleven. She was one of seven children, 40 00:02:10,960 --> 00:02:13,680 Speaker 1: and her parents were dairy farmers. Her mother was also 41 00:02:13,720 --> 00:02:16,880 Speaker 1: a teacher. Vera and her siblings worked on the farm, 42 00:02:16,960 --> 00:02:19,920 Speaker 1: starting at a very early age, particularly after the sudden 43 00:02:19,960 --> 00:02:23,040 Speaker 1: death of their father. Her first education was in a 44 00:02:23,080 --> 00:02:27,480 Speaker 1: one room schoolhouse. She finished high school at sixteen, and 45 00:02:27,560 --> 00:02:29,680 Speaker 1: she wanted to knew already that she wanted to become 46 00:02:29,680 --> 00:02:33,280 Speaker 1: a doctor. She was too young to start medical school, though, 47 00:02:33,400 --> 00:02:36,000 Speaker 1: so she enrolled in the University of Toronto to study 48 00:02:36,040 --> 00:02:38,760 Speaker 1: math and physics, and then she transferred to the medical 49 00:02:38,800 --> 00:02:42,280 Speaker 1: program the following year. She worked summer jobs to save 50 00:02:42,360 --> 00:02:44,640 Speaker 1: up her money, and her brother and her sisters helped 51 00:02:44,680 --> 00:02:47,680 Speaker 1: pay her way as well. While she was working as 52 00:02:47,720 --> 00:02:50,680 Speaker 1: a waitress on a tourist ship, she met Ken Lobb, 53 00:02:50,800 --> 00:02:53,040 Speaker 1: who was the man she would later marry and they 54 00:02:53,040 --> 00:02:57,400 Speaker 1: would eventually have two daughters together. While she was still 55 00:02:57,400 --> 00:03:00,400 Speaker 1: in medical school, her mother was treated for breast cancer, 56 00:03:00,520 --> 00:03:04,400 Speaker 1: and after a recurrence, she was treated by Dr Gordon Richards, 57 00:03:04,400 --> 00:03:06,400 Speaker 1: who at that point was one of the most respected 58 00:03:06,440 --> 00:03:10,120 Speaker 1: doctors in the field of radiation oncology, which at that 59 00:03:10,160 --> 00:03:15,160 Speaker 1: point was pretty early in in its development. Dr Richards 60 00:03:15,200 --> 00:03:18,040 Speaker 1: was also one of the doctors that there is studied under, 61 00:03:18,320 --> 00:03:21,880 Speaker 1: and Vera's mother unfortunately did die for cancer, which was 62 00:03:21,919 --> 00:03:23,800 Speaker 1: one of the things that led Bevera to want to 63 00:03:23,840 --> 00:03:28,200 Speaker 1: study the disease later in her life. Dr Peters graduated 64 00:03:28,200 --> 00:03:31,360 Speaker 1: from medical school in nineteen thirty four and went on 65 00:03:31,440 --> 00:03:35,720 Speaker 1: to a residency in radiology at Toronto General Hospital. At 66 00:03:35,720 --> 00:03:38,760 Speaker 1: this point in medicine, there was no official training protocol 67 00:03:38,920 --> 00:03:43,160 Speaker 1: or certification for radiotherapy, so Dr Peters apprenticed with Dr 68 00:03:43,280 --> 00:03:46,440 Speaker 1: Richards and she started working at the Ontario Institute of 69 00:03:46,520 --> 00:03:50,320 Speaker 1: Radiotherapy in ninety five, and she continued to work with 70 00:03:50,440 --> 00:03:52,880 Speaker 1: Dr Richards right up until his death in January of 71 00:03:52,960 --> 00:03:57,360 Speaker 1: ninety nine. Before we get into more of the specifics 72 00:03:57,360 --> 00:04:00,480 Speaker 1: of her medical work, here's a caveat dot Or. Peters 73 00:04:00,480 --> 00:04:04,000 Speaker 1: did really groundbreaking work and the treatment of two different cancers, 74 00:04:04,040 --> 00:04:06,160 Speaker 1: and we're going to talk about them enough to give 75 00:04:06,200 --> 00:04:08,680 Speaker 1: a sense of why her work was so important. But 76 00:04:08,720 --> 00:04:11,600 Speaker 1: this is absolutely not meant to be a thorough exploration 77 00:04:11,680 --> 00:04:15,520 Speaker 1: of either cancer, uh even or even of the human 78 00:04:15,560 --> 00:04:19,240 Speaker 1: body systems that they involved. This is also definitely not 79 00:04:19,320 --> 00:04:22,840 Speaker 1: a thorough examination of how these cancers are treated today, 80 00:04:22,920 --> 00:04:26,560 Speaker 1: because the whole field of oncology has evolved tremendously since 81 00:04:26,680 --> 00:04:30,240 Speaker 1: Dr Peters retired in nineteen seventy six. So this is 82 00:04:30,320 --> 00:04:33,480 Speaker 1: much more about how the developments that Dr Peters helped 83 00:04:33,560 --> 00:04:36,880 Speaker 1: launched changed the way medicine was working at time than 84 00:04:36,920 --> 00:04:41,120 Speaker 1: about the diseases specifically or how they're treated today. So 85 00:04:41,320 --> 00:04:44,640 Speaker 1: Dr peters first groundbreaking work was in the treatment of 86 00:04:44,680 --> 00:04:49,160 Speaker 1: Hodgkin's disease, which was before that point considered to be incurable. 87 00:04:50,320 --> 00:04:53,240 Speaker 1: Now more commonly known as Hodgkins lymphoma, this is a 88 00:04:53,279 --> 00:04:56,640 Speaker 1: cancer that affects the lymphatic system. It's name for Dr 89 00:04:56,720 --> 00:05:00,200 Speaker 1: Thomas Hodgkin, who described it in eighteen thirty two, whom 90 00:05:00,839 --> 00:05:03,880 Speaker 1: The major difference between Hodgkins lymphoma and the more common 91 00:05:03,960 --> 00:05:08,600 Speaker 1: non Hodgkins lymphoma is that Hodgkins lymphoma involves large, abnormal 92 00:05:08,640 --> 00:05:12,840 Speaker 1: cells called read Sternberg cells, while these cells are not 93 00:05:13,000 --> 00:05:18,039 Speaker 1: present in non Hodgkins lymphoma. Between its first description in 94 00:05:18,080 --> 00:05:22,240 Speaker 1: eighteen thirty two and nineteen o two, no doctors reported 95 00:05:22,279 --> 00:05:26,599 Speaker 1: any successful treatment of Hodgkins lymphoma at all. The first 96 00:05:26,839 --> 00:05:30,520 Speaker 1: somewhat successful treatment was, which was described in nineteen o two, 97 00:05:30,560 --> 00:05:33,760 Speaker 1: was the use of X rays on the involved lymph nodes, 98 00:05:33,880 --> 00:05:37,640 Speaker 1: and while this did shrink the affected nodes somewhat, it 99 00:05:37,720 --> 00:05:40,960 Speaker 1: didn't cure the disease, it maybe bought people a little time. 100 00:05:41,839 --> 00:05:44,480 Speaker 1: There were a few advances between nineteen o two and 101 00:05:44,600 --> 00:05:48,159 Speaker 1: nineteen thirty nine, when Dr rhinegel Bare of Geneva, Switzerland 102 00:05:48,480 --> 00:05:52,719 Speaker 1: described treating the affected lymph nodes with radiation. He treated 103 00:05:52,760 --> 00:05:55,440 Speaker 1: both the affected lymph nodes and other parts of the 104 00:05:55,440 --> 00:05:58,440 Speaker 1: body that were not apparently affected, and while some of 105 00:05:58,480 --> 00:06:01,680 Speaker 1: his patients did improve, many relapsed, and he didn't think 106 00:06:01,680 --> 00:06:05,640 Speaker 1: of any of them as having been cured. Dr Peter's mentor, 107 00:06:05,800 --> 00:06:09,599 Speaker 1: Doctor Richards, who we mentioned earlier, installed a four hundred 108 00:06:09,680 --> 00:06:14,400 Speaker 1: kilt radiation machine at the Ontario Radiotherapy Institute in ninety seven, 109 00:06:14,480 --> 00:06:17,719 Speaker 1: just a couple of years before doctor Jilbert's description of 110 00:06:17,760 --> 00:06:21,359 Speaker 1: his method. This was a higher voltage machine than what 111 00:06:21,560 --> 00:06:25,440 Speaker 1: doctor Gilbert was using, and Dr Richard used this machine 112 00:06:25,520 --> 00:06:29,440 Speaker 1: to treat his patients for a variety of cancers. Dr 113 00:06:29,600 --> 00:06:33,320 Speaker 1: Richard's method with Hodgkins lymphoma was to use extended field 114 00:06:33,440 --> 00:06:37,800 Speaker 1: radiation on the affected lymph nodes and adjacent nodes. Although 115 00:06:37,800 --> 00:06:42,000 Speaker 1: some accounts described this a radiation of nearby nodes as prophylactic, 116 00:06:42,440 --> 00:06:45,360 Speaker 1: it wasn't really to prevent disease. It was to kill 117 00:06:45,440 --> 00:06:48,719 Speaker 1: cancerous cells that had already spread to adjacent nodes but 118 00:06:48,839 --> 00:06:53,520 Speaker 1: weren't yet detectable. At first, Dr Peters primarily worked under 119 00:06:53,640 --> 00:06:56,760 Speaker 1: Dr Richard's supervision. She was kind of apprenticing to him, 120 00:06:57,200 --> 00:06:59,520 Speaker 1: but as she became more experienced as a doctor, she 121 00:06:59,600 --> 00:07:02,440 Speaker 1: began to treat patients on her own as well. In 122 00:07:04,200 --> 00:07:07,000 Speaker 1: after ten years of treating lymphoma patients with the four 123 00:07:07,400 --> 00:07:11,920 Speaker 1: Kabot machine, Dr Richards made an observation to Dr Peters. 124 00:07:12,080 --> 00:07:14,280 Speaker 1: It seemed to him that some of their patients were 125 00:07:14,280 --> 00:07:17,640 Speaker 1: surviving a long time with no relapse, even though Hodgkins 126 00:07:17,720 --> 00:07:21,400 Speaker 1: lymphoma was supposedly incurable, and he asked her how she 127 00:07:21,480 --> 00:07:25,440 Speaker 1: wanted to evaluate their work on the matter. So there 128 00:07:25,440 --> 00:07:27,960 Speaker 1: are some people who interpret this as meaning that Dr 129 00:07:28,120 --> 00:07:31,040 Speaker 1: Richards should get credit for what happened next. After all, 130 00:07:31,160 --> 00:07:32,960 Speaker 1: especially at the beginning, he was the one who was 131 00:07:33,000 --> 00:07:36,800 Speaker 1: successfully treating the patients for their cancer. But what he 132 00:07:36,920 --> 00:07:40,400 Speaker 1: really did was give Dr Peters a question to answer, 133 00:07:40,600 --> 00:07:43,440 Speaker 1: and the work she did to answer that question eventually 134 00:07:43,520 --> 00:07:47,560 Speaker 1: changed the perception of Hodgkins lymphoma for being an incurable 135 00:07:47,560 --> 00:07:52,120 Speaker 1: disease to a curable one. Dr Peter spent two years 136 00:07:52,160 --> 00:07:55,800 Speaker 1: studying one hundred and thirteen patients who had been conclusively 137 00:07:55,840 --> 00:07:59,560 Speaker 1: diagnosed with Hodgkins lymphoma and treated with radiation at the 138 00:07:59,600 --> 00:08:02,560 Speaker 1: hospital to where she worked. She largely did this by 139 00:08:02,640 --> 00:08:05,640 Speaker 1: hand at her dining room table. She was ready to 140 00:08:05,680 --> 00:08:09,000 Speaker 1: present her findings to her colleagues in ninety nine, which was, 141 00:08:09,080 --> 00:08:14,440 Speaker 1: unfortunately after Dr Richards had already died. Her findings revealed, though, 142 00:08:14,480 --> 00:08:18,040 Speaker 1: that his theory was right. Their patients were living longer 143 00:08:18,080 --> 00:08:22,040 Speaker 1: than limphoma patients at other hospitals. Their five year survival 144 00:08:22,120 --> 00:08:25,200 Speaker 1: rate had doubled and their ten year survival rate had tripled. 145 00:08:25,680 --> 00:08:29,040 Speaker 1: Patients in Stage one, which was the least advanced stage, 146 00:08:29,080 --> 00:08:32,720 Speaker 1: lived a median of eleven point six years, and she 147 00:08:32,800 --> 00:08:36,440 Speaker 1: didn't describe any of the patients as cured, but their 148 00:08:36,440 --> 00:08:39,240 Speaker 1: prognosis was really a lot better, and her tone was 149 00:08:39,280 --> 00:08:42,200 Speaker 1: a lot more optimistic than any of the medical wisdom 150 00:08:42,280 --> 00:08:47,120 Speaker 1: on Hodgkin's lymphoma at the time. The idea of approaching 151 00:08:47,120 --> 00:08:50,960 Speaker 1: Hodgkins lymphoma with the goal of curing it was revolutionary, 152 00:08:51,559 --> 00:08:54,320 Speaker 1: and even though Dr Peters had clear, compelling data to 153 00:08:54,360 --> 00:08:56,920 Speaker 1: back up what she was saying, it took about ten 154 00:08:57,000 --> 00:09:00,640 Speaker 1: years for the medical establishment to start taking this concept seriously. 155 00:09:02,480 --> 00:09:05,680 Speaker 1: Dr Peters presented a follow up paper in nineteen fifty 156 00:09:05,720 --> 00:09:10,800 Speaker 1: six that included two Hodgkins lymphoma cases with all of 157 00:09:10,840 --> 00:09:13,800 Speaker 1: the data just as solidly pointing to the idea that 158 00:09:13,840 --> 00:09:17,760 Speaker 1: Hodgkins disease could be cured, especially in the early stages. 159 00:09:18,280 --> 00:09:20,959 Speaker 1: But perceptions in the medical field didn't really start to 160 00:09:21,080 --> 00:09:25,040 Speaker 1: change until Eric C. Easton and Marian H. Russell, using 161 00:09:25,160 --> 00:09:29,160 Speaker 1: Dr Peters data confirmed her work in their paper Cure 162 00:09:29,320 --> 00:09:33,800 Speaker 1: of Hodgkins Disease that was in nineteen sixty three. Uh, 163 00:09:33,840 --> 00:09:36,560 Speaker 1: it took even longer than that for the idea that 164 00:09:36,600 --> 00:09:39,720 Speaker 1: Hodgkins disease could be approached as something that can be 165 00:09:39,840 --> 00:09:45,200 Speaker 1: cured in a medical textbook. Treatments have continued to advance today, 166 00:09:45,320 --> 00:09:48,800 Speaker 1: especially if it's caught in the early stages. Hodgkins disease 167 00:09:48,840 --> 00:09:52,160 Speaker 1: is considered to be one of the most curable adult cancers. 168 00:09:53,760 --> 00:09:57,000 Speaker 1: Having made these kinds of strides and Hodgkins disease, Dr 169 00:09:57,040 --> 00:09:59,800 Speaker 1: Peters turned her focus to breast cancer, which was personally 170 00:10:00,000 --> 00:10:02,280 Speaker 1: important to her because of her mother, And we'll talk 171 00:10:02,320 --> 00:10:04,760 Speaker 1: about that work after a brief ad break. So to 172 00:10:04,800 --> 00:10:07,480 Speaker 1: get back to Dr peters work with breast cancer in 173 00:10:08,520 --> 00:10:12,160 Speaker 1: the Ontario Cancer Institute at Princess Margaret Hospital opened and 174 00:10:12,240 --> 00:10:15,920 Speaker 1: patients and staff from Toronto General, including Dr Peters and 175 00:10:15,960 --> 00:10:20,320 Speaker 1: her patients, were transferred there. As a side note, we're 176 00:10:20,320 --> 00:10:22,480 Speaker 1: about to talk about breast cancer for a while, and 177 00:10:22,520 --> 00:10:25,480 Speaker 1: while men can and do get breast cancer, we're really 178 00:10:25,520 --> 00:10:27,960 Speaker 1: going to be talking about women here because that's the 179 00:10:28,000 --> 00:10:31,800 Speaker 1: work that Dr Peters was doing. All of her focus 180 00:10:31,840 --> 00:10:34,280 Speaker 1: was on breast cancer treatment in women, not in men's, 181 00:10:34,280 --> 00:10:37,960 Speaker 1: so we're not excluding men for some other reason. That's 182 00:10:38,000 --> 00:10:41,360 Speaker 1: just the work that she was focused on. So at 183 00:10:41,400 --> 00:10:44,880 Speaker 1: this point, the overwhelming majority of patients who were diagnosed 184 00:10:44,920 --> 00:10:48,520 Speaker 1: with breast cancer were treated with a radical mastectomy also 185 00:10:48,559 --> 00:10:51,599 Speaker 1: called the Halstead procedure for the doctor who popularized it. 186 00:10:52,080 --> 00:10:54,600 Speaker 1: Almost as soon as they were diagnosed, they would go 187 00:10:54,640 --> 00:10:57,479 Speaker 1: in for a biopsy, which was done under general anesthesia, 188 00:10:57,920 --> 00:11:00,480 Speaker 1: and if the lump was cancers, they'd have them stectomy 189 00:11:00,559 --> 00:11:04,400 Speaker 1: before they regained consciousness. This made the possibility of breast 190 00:11:04,400 --> 00:11:09,080 Speaker 1: cancer particularly terrifying. Women got onto an operating table not 191 00:11:09,240 --> 00:11:11,840 Speaker 1: knowing if they had cancer or not, and not knowing 192 00:11:11,880 --> 00:11:14,000 Speaker 1: if they would wake up without a breast or not. 193 00:11:14,679 --> 00:11:18,280 Speaker 1: The mostectomy itself, which was the standard treatment regardless of 194 00:11:18,280 --> 00:11:21,640 Speaker 1: whether the cancer had spread beyond one tumor, was a 195 00:11:21,720 --> 00:11:26,200 Speaker 1: lot more involved than messtectomys typically are today. A radical 196 00:11:26,240 --> 00:11:29,320 Speaker 1: mastectomy removes more than just the breast. It also removes 197 00:11:29,360 --> 00:11:33,040 Speaker 1: the pectoral muscles under the breast, along with the lymph 198 00:11:33,040 --> 00:11:35,400 Speaker 1: nodes under the arm on the same side as the 199 00:11:35,400 --> 00:11:39,600 Speaker 1: affected breast. This idea was that the cancer was less 200 00:11:39,600 --> 00:11:42,160 Speaker 1: likely to spread if you literally removed all of the 201 00:11:42,240 --> 00:11:45,079 Speaker 1: things adjacent to it where it was most likely to spread. 202 00:11:45,720 --> 00:11:48,600 Speaker 1: And you know, while these are the places that cancer 203 00:11:48,920 --> 00:11:51,880 Speaker 1: is most likely to go after appearing in the breast, 204 00:11:52,679 --> 00:11:55,319 Speaker 1: this court was the course of action regardless of whether 205 00:11:55,360 --> 00:11:58,000 Speaker 1: cancer had been detected in any of these other places. 206 00:12:00,080 --> 00:12:04,440 Speaker 1: Less to say, a radical mass ectomy permanently and significantly 207 00:12:04,480 --> 00:12:08,840 Speaker 1: altered the body. Even after the reconstruction, a woman's chest 208 00:12:08,840 --> 00:12:11,440 Speaker 1: itself would look a lot different. It would basically be 209 00:12:11,679 --> 00:12:14,360 Speaker 1: concave because of the loss of the pectoral muscle wall 210 00:12:15,280 --> 00:12:18,560 Speaker 1: Over and over again. Modern medical papers described radical mass 211 00:12:18,600 --> 00:12:22,360 Speaker 1: ectomies of the past as and this is quote disfiguring 212 00:12:23,760 --> 00:12:26,000 Speaker 1: such a huge change to such a personal part of 213 00:12:26,000 --> 00:12:29,840 Speaker 1: the body was psychologically and emotionally damaging. For many patients 214 00:12:29,880 --> 00:12:33,920 Speaker 1: for the rest of their lives. Can also be physically disabling, 215 00:12:33,960 --> 00:12:36,480 Speaker 1: since it removed some of the muscles used to control 216 00:12:36,520 --> 00:12:40,360 Speaker 1: a person's arm, and the loss of lymph nodes can 217 00:12:40,440 --> 00:12:43,960 Speaker 1: lead to permanent swelling and an increased likelihood of infections 218 00:12:44,000 --> 00:12:47,760 Speaker 1: in the arm. Nerve damage was also a really frequent complication, 219 00:12:48,559 --> 00:12:51,559 Speaker 1: and this is why today radical mess ectomy is extremely 220 00:12:51,679 --> 00:12:54,480 Speaker 1: rare and it's only performed when there really is cancer 221 00:12:54,559 --> 00:12:58,080 Speaker 1: in those adjacent tissues. When people have mass ectomies today, 222 00:12:58,120 --> 00:13:01,560 Speaker 1: they're usually what's considered a full mastectomy, which removes the 223 00:13:01,600 --> 00:13:04,280 Speaker 1: breast but leaves at least some of the lymph nodes, 224 00:13:04,600 --> 00:13:07,520 Speaker 1: or a modified radical mast ectomy, which removes the breast 225 00:13:07,559 --> 00:13:10,720 Speaker 1: and lymph nodes but only gets into the pectoral muscles 226 00:13:10,760 --> 00:13:14,800 Speaker 1: if the cancer has actually spread there. Even though a 227 00:13:14,880 --> 00:13:18,079 Speaker 1: radical mastectomy was a standard of care for breast cancer 228 00:13:18,120 --> 00:13:20,559 Speaker 1: patients at this point, there were a few people who 229 00:13:20,559 --> 00:13:23,800 Speaker 1: didn't have them because of other medical conditions, or, in 230 00:13:23,840 --> 00:13:26,920 Speaker 1: a very limited number of cases, the patients who just 231 00:13:26,960 --> 00:13:30,240 Speaker 1: put their foot down and refused to have more aggressive surgery. 232 00:13:30,800 --> 00:13:33,960 Speaker 1: These patients had surgeries that conserved more of their breast. 233 00:13:34,040 --> 00:13:37,000 Speaker 1: It was either a simple mastectomy or a lump ectomy. 234 00:13:37,160 --> 00:13:40,120 Speaker 1: Unless there was some medical reason why a woman could 235 00:13:40,160 --> 00:13:43,640 Speaker 1: not have a radical mastectomy, these options were pretty much 236 00:13:43,679 --> 00:13:49,160 Speaker 1: always against medical advice. Dr Peter's previous work with lymphoma 237 00:13:49,280 --> 00:13:52,120 Speaker 1: meant she was particularly insightful when it came to how 238 00:13:52,160 --> 00:13:56,440 Speaker 1: cancer spread through the lymphatic system. Patients were often referred 239 00:13:56,480 --> 00:13:59,920 Speaker 1: to her for follow up radiation treatment after their surgery, 240 00:14:00,640 --> 00:14:03,720 Speaker 1: and she also had personal experience with how traumatic breast 241 00:14:03,760 --> 00:14:06,120 Speaker 1: cancer treatment could be after she had lost her mother 242 00:14:06,200 --> 00:14:09,319 Speaker 1: to the disease in nineteen thirty three, so she wanted 243 00:14:09,320 --> 00:14:11,960 Speaker 1: to see if less drastic treatments could prove to be 244 00:14:12,000 --> 00:14:15,360 Speaker 1: as effective as a mastectomy while still preserving as much 245 00:14:15,400 --> 00:14:19,240 Speaker 1: of the breast as possible. She published her first work 246 00:14:19,240 --> 00:14:21,600 Speaker 1: on the subject in nineteen sixty seven, and it was 247 00:14:21,640 --> 00:14:24,520 Speaker 1: based on comparing the survival rates for women who had 248 00:14:24,560 --> 00:14:28,320 Speaker 1: been treated for their cancer with different forms of treatment. 249 00:14:29,000 --> 00:14:31,840 Speaker 1: She studied the record of seven thousand patients who had 250 00:14:31,840 --> 00:14:35,600 Speaker 1: been treated between nineteen thirty five and nineteen sixty eight. 251 00:14:35,680 --> 00:14:37,920 Speaker 1: Hundred and fifty two of these patients had had their 252 00:14:38,000 --> 00:14:42,040 Speaker 1: lump removed during their biopsy. A hundred and twenty four 253 00:14:42,080 --> 00:14:45,240 Speaker 1: of those had radiation as their only follow up treatment, 254 00:14:45,280 --> 00:14:49,040 Speaker 1: while the others had some combination of a masstectomy and radiation. 255 00:14:49,840 --> 00:14:52,760 Speaker 1: What she found was that there was absolutely no difference 256 00:14:52,800 --> 00:14:55,920 Speaker 1: in the survival time between the women who had just 257 00:14:56,040 --> 00:14:58,000 Speaker 1: had a lambectomy when the women who had had a 258 00:14:58,080 --> 00:15:01,520 Speaker 1: mastectomy when it came to women with stage one and 259 00:15:01,640 --> 00:15:05,160 Speaker 1: stage two breast cancer, in her opinion, the more conservative 260 00:15:05,240 --> 00:15:08,920 Speaker 1: surgery which preserved the woman's breast was just as viable 261 00:15:08,960 --> 00:15:12,240 Speaker 1: a medical option as a mestectomy. And this was a 262 00:15:12,360 --> 00:15:16,880 Speaker 1: completely controversial stance at the time. In her words, quote, 263 00:15:17,040 --> 00:15:19,760 Speaker 1: I was refuted and shunned by most of the outstanding 264 00:15:19,760 --> 00:15:23,680 Speaker 1: surgeons in the States, except for Dr George Cryle of Cleveland. 265 00:15:25,400 --> 00:15:28,480 Speaker 1: She was determined, though, and so she decided to do 266 00:15:28,560 --> 00:15:31,480 Speaker 1: a case a case control study of the records from 267 00:15:31,480 --> 00:15:34,560 Speaker 1: Princess Margaret Hospital. So while she had previously combed through 268 00:15:34,640 --> 00:15:36,680 Speaker 1: all of the records and looked at them as a whole, 269 00:15:37,400 --> 00:15:39,960 Speaker 1: this time she controlled for the age of the patients, 270 00:15:40,200 --> 00:15:44,200 Speaker 1: there are other health factors, whether they also had other cancers. 271 00:15:44,240 --> 00:15:46,920 Speaker 1: She narrowed it down to only patients with stage one 272 00:15:47,000 --> 00:15:49,920 Speaker 1: breast cancer, and then she meticulously matched up the ones 273 00:15:49,960 --> 00:15:53,200 Speaker 1: who had a lump ectomy and radiation with the ones 274 00:15:53,240 --> 00:15:56,040 Speaker 1: who had a mess spectomy and radiation, and to match 275 00:15:56,080 --> 00:15:58,400 Speaker 1: them up she looked at their ages, how large the 276 00:15:58,440 --> 00:16:00,880 Speaker 1: tumor was, and the year that the treatment took place. 277 00:16:01,800 --> 00:16:05,080 Speaker 1: This gave her a hundred and forty five pairs in 278 00:16:05,120 --> 00:16:08,760 Speaker 1: which the lampectomy group had no statistically significant difference than 279 00:16:08,800 --> 00:16:12,280 Speaker 1: the massed ectomy group. In fact, the lumpectomy group had 280 00:16:12,280 --> 00:16:16,120 Speaker 1: slightly better survival than the mast ectomy group. In other words, 281 00:16:16,200 --> 00:16:19,240 Speaker 1: for women with stage one cancer, a more conservative treatment 282 00:16:19,320 --> 00:16:22,600 Speaker 1: that preserved their breasts did not harm their chances of survival. 283 00:16:23,480 --> 00:16:26,560 Speaker 1: Radical mass ectomy was not necessary when the disease had 284 00:16:26,600 --> 00:16:31,000 Speaker 1: not started to spread. In nineteen seventy five, she presented 285 00:16:31,040 --> 00:16:33,880 Speaker 1: these findings at the Royal College of Physicians and Surgeons 286 00:16:33,920 --> 00:16:38,280 Speaker 1: of Canada meeting in Winnipeg, Manitoba. Their response was really 287 00:16:38,320 --> 00:16:42,560 Speaker 1: skeptical at best. Two years later, Dr Peters published an 288 00:16:42,640 --> 00:16:45,600 Speaker 1: updated version of the paper and an international journal which 289 00:16:45,920 --> 00:16:48,120 Speaker 1: gave it more exposure and also came to the exact 290 00:16:48,160 --> 00:16:51,440 Speaker 1: same conclusions. In that paper, she was really direct in 291 00:16:51,440 --> 00:16:55,240 Speaker 1: her opinion, she said, quote as more and more conservative 292 00:16:55,280 --> 00:16:59,280 Speaker 1: studies ripen, as more and more concerned physicians observed the 293 00:16:59,320 --> 00:17:02,800 Speaker 1: adverse effect of excessive treatment. As more and more women 294 00:17:02,840 --> 00:17:06,359 Speaker 1: become armed with knowledge, mastectomy and early breast cancer may 295 00:17:06,400 --> 00:17:10,920 Speaker 1: become as old fashioned as bloodletting. Dr Peters retired from 296 00:17:10,920 --> 00:17:14,160 Speaker 1: the hospital the year before that revised paper was published, 297 00:17:14,440 --> 00:17:17,280 Speaker 1: although she maintained a part time practice and she continued 298 00:17:17,320 --> 00:17:22,199 Speaker 1: to teach. But gradually oncologists did start taking a more 299 00:17:22,320 --> 00:17:26,720 Speaker 1: conservative approach to early stage breast cancers. Today, women with 300 00:17:26,760 --> 00:17:29,840 Speaker 1: early stage breast cancer generally have a mestectomy if there's 301 00:17:29,920 --> 00:17:34,680 Speaker 1: some medical reason to do so. Dr peters impact on 302 00:17:34,720 --> 00:17:37,800 Speaker 1: the medical field also went beyond just the specific treatment 303 00:17:37,840 --> 00:17:40,240 Speaker 1: of these two cancers, and we'll talk about how after 304 00:17:40,359 --> 00:17:44,760 Speaker 1: a brief ad break so to return to Dr Peters. 305 00:17:45,080 --> 00:17:48,680 Speaker 1: A lot of people take the idea of patient centered 306 00:17:48,760 --> 00:17:51,640 Speaker 1: care to for granted today, even if they've never heard 307 00:17:51,680 --> 00:17:54,760 Speaker 1: that term specifically. I know that lots of people have 308 00:17:55,000 --> 00:17:58,000 Speaker 1: lots of different access to medical care, depending on all 309 00:17:58,080 --> 00:18:00,680 Speaker 1: kinds of factors, including their income, love on their age, 310 00:18:00,680 --> 00:18:03,840 Speaker 1: and their race, and lots lots of different issues. But 311 00:18:03,920 --> 00:18:05,520 Speaker 1: for the most part, when people go to the doctor, 312 00:18:05,600 --> 00:18:07,639 Speaker 1: they kind of expect their doctor to treat them like 313 00:18:07,640 --> 00:18:09,639 Speaker 1: a human being and to listen to them and to 314 00:18:09,840 --> 00:18:14,600 Speaker 1: explain what's going on. And uh, this was not really 315 00:18:14,760 --> 00:18:19,320 Speaker 1: how things worked. When Dr Peters started practicing medicine, she 316 00:18:19,480 --> 00:18:22,760 Speaker 1: was really a forerunner in the idea of listening to 317 00:18:22,880 --> 00:18:26,440 Speaker 1: a patient's wishes and explaining to them and helping them 318 00:18:26,440 --> 00:18:30,520 Speaker 1: make decisions about their own treatment. Uh, this whole idea 319 00:18:30,640 --> 00:18:35,760 Speaker 1: was really far from standard at when she was practicing medicine. Yeah, 320 00:18:35,760 --> 00:18:38,160 Speaker 1: she actually got to know her patients and she helped 321 00:18:38,160 --> 00:18:40,600 Speaker 1: them make decisions about their own health care, rather than 322 00:18:40,640 --> 00:18:42,879 Speaker 1: just seeing them as a condition to treat and telling 323 00:18:42,920 --> 00:18:47,040 Speaker 1: them what to do. Another common attitude today is that 324 00:18:47,040 --> 00:18:48,800 Speaker 1: when you go to the doctor, you should get a 325 00:18:48,840 --> 00:18:51,120 Speaker 1: treatment that's going to be the right amount to solve 326 00:18:51,160 --> 00:18:54,280 Speaker 1: the problem, not something that's just going to be so 327 00:18:54,400 --> 00:18:57,520 Speaker 1: completely aggressive that it's going to blast the problem away 328 00:18:57,560 --> 00:19:00,520 Speaker 1: but then also leave you with potentially lots of scars, 329 00:19:00,520 --> 00:19:04,040 Speaker 1: are huge side effects, or you know, lots of adverse 330 00:19:04,080 --> 00:19:07,320 Speaker 1: effects to taking care of the problem. This was also 331 00:19:07,480 --> 00:19:10,639 Speaker 1: core to Dr Peter's philosophy as a doctor. She wanted 332 00:19:10,680 --> 00:19:13,600 Speaker 1: to do the most conservative treatment to get the job done, 333 00:19:14,119 --> 00:19:15,840 Speaker 1: and it was really different from a lot of what 334 00:19:15,920 --> 00:19:19,160 Speaker 1: was going on at the time. Obviously, doctors were putting 335 00:19:19,160 --> 00:19:20,960 Speaker 1: women to sleep to do a biopsy, and then taking 336 00:19:21,000 --> 00:19:23,160 Speaker 1: their entire breast, even in the case of really small 337 00:19:23,160 --> 00:19:26,959 Speaker 1: tumors that hadn't progressed anywhere. Um, she really wanted to 338 00:19:27,040 --> 00:19:30,280 Speaker 1: avoid the risks that came of side effects and other 339 00:19:30,320 --> 00:19:33,760 Speaker 1: complications by doing a more minimal treatment but still treading 340 00:19:33,800 --> 00:19:37,240 Speaker 1: the actual problem. And she was also a role model 341 00:19:37,320 --> 00:19:40,080 Speaker 1: for young women who were interested in becoming doctors, not 342 00:19:40,200 --> 00:19:42,840 Speaker 1: just because of her success as a doctor, but also 343 00:19:42,880 --> 00:19:44,879 Speaker 1: because she proved that a woman could be a doctor 344 00:19:44,880 --> 00:19:47,359 Speaker 1: while also being a wife and mother, and that was 345 00:19:47,400 --> 00:19:49,919 Speaker 1: something that really needed proving at this point in history. 346 00:19:50,440 --> 00:19:52,600 Speaker 1: She did a lot of her research at home, so 347 00:19:52,800 --> 00:19:54,960 Speaker 1: she was compilingly her work by hand. She wouldn't have 348 00:19:54,960 --> 00:19:57,600 Speaker 1: been able to make the breakthroughs that she did otherwise, 349 00:19:58,119 --> 00:20:00,399 Speaker 1: but outside the of the medical world old she was 350 00:20:00,560 --> 00:20:04,119 Speaker 1: Mrs lob mother of two. I think a lot of 351 00:20:04,119 --> 00:20:07,240 Speaker 1: the other like female forerunners in the world of medicine 352 00:20:07,320 --> 00:20:12,160 Speaker 1: we've talked about, have been women who eschewed the more traditional, 353 00:20:12,400 --> 00:20:17,840 Speaker 1: stereotypical feminine side. And so it actually was a big 354 00:20:17,880 --> 00:20:19,840 Speaker 1: deal that in addition to being a doctor, she got 355 00:20:19,840 --> 00:20:24,240 Speaker 1: married and had children. Uh, all of this work was 356 00:20:24,280 --> 00:20:27,160 Speaker 1: additionally incredible because at this point there were hardly any 357 00:20:27,160 --> 00:20:30,360 Speaker 1: women doctors at all, let alone women doctors who were 358 00:20:30,359 --> 00:20:33,760 Speaker 1: on the cutting edge of their field, revolutionizing the treatment 359 00:20:33,760 --> 00:20:37,440 Speaker 1: of multiple diseases. And Dr Vera Peters became an Officer 360 00:20:37,560 --> 00:20:40,720 Speaker 1: of the Order of Canada in nineteen seventy eight. She 361 00:20:40,840 --> 00:20:43,359 Speaker 1: was awarded the Gold Medal from the American Society of 362 00:20:43,400 --> 00:20:46,960 Speaker 1: Therapeutic Radiology in nineteen seventy nine and the Woman of 363 00:20:47,000 --> 00:20:52,720 Speaker 1: Distinction Award from the Canadian Breast Cancer Foundation in Sadly, 364 00:20:52,800 --> 00:20:56,119 Speaker 1: she died of cancer on October one, nine at the 365 00:20:56,160 --> 00:20:59,359 Speaker 1: age of eighty two. She died at Princess Margaret Hospital 366 00:20:59,400 --> 00:21:02,439 Speaker 1: in Toronto, where she had worked for most of her career, 367 00:21:03,119 --> 00:21:06,040 Speaker 1: and she was inducted into the Canadian Medical Hall of Fame. 368 00:21:06,200 --> 00:21:09,720 Speaker 1: In It's kind of a side note, there was a 369 00:21:09,800 --> 00:21:13,120 Speaker 1: play about her called Radical, which was written by Charles Hayter, 370 00:21:13,160 --> 00:21:17,520 Speaker 1: who was also an oncologist, that actually premiered to just 371 00:21:17,800 --> 00:21:20,879 Speaker 1: sell out standing room only crowd at the Toronto French 372 00:21:20,920 --> 00:21:26,199 Speaker 1: Festival in July. Thank you, Dr Vera Peters. I know 373 00:21:28,119 --> 00:21:30,800 Speaker 1: you and I both have family experience with breast cancer. 374 00:21:31,080 --> 00:21:33,600 Speaker 1: And the fact that somebody said, okay, we we have 375 00:21:33,640 --> 00:21:39,439 Speaker 1: got to just stop treating women as a thing to 376 00:21:39,440 --> 00:21:41,399 Speaker 1: put on a table and remove part of their body 377 00:21:41,520 --> 00:21:44,359 Speaker 1: without actually talking to them about it. Like that's a 378 00:21:44,400 --> 00:21:48,920 Speaker 1: big deal. The idea of um not being asked questions 379 00:21:48,960 --> 00:21:55,360 Speaker 1: about treatment is so alien to me that it's shocking. Yeah, yeah, 380 00:21:55,640 --> 00:21:58,879 Speaker 1: uh and you I said this to you off Mike, 381 00:21:58,960 --> 00:22:01,240 Speaker 1: and now I'm just gonna say it on Like, as 382 00:22:01,280 --> 00:22:04,119 Speaker 1: I was researching this, I found a citation of that 383 00:22:04,240 --> 00:22:08,359 Speaker 1: cure for Hodgkins disease paper. It was like a citation 384 00:22:08,400 --> 00:22:12,000 Speaker 1: of the paper that was in another, uh, another journal 385 00:22:12,400 --> 00:22:16,159 Speaker 1: and incited the male doctor is doctor and the female 386 00:22:16,160 --> 00:22:18,159 Speaker 1: author of the paper is miss. And I could not 387 00:22:18,320 --> 00:22:22,879 Speaker 1: figure out whether she was actually a doctor when that 388 00:22:23,560 --> 00:22:26,919 Speaker 1: notation was published or not, because it is possible that 389 00:22:26,960 --> 00:22:29,160 Speaker 1: she was credited on the paper but was not yet 390 00:22:29,640 --> 00:22:34,200 Speaker 1: a medical doctor. But I sincerely wonder, based on all 391 00:22:34,240 --> 00:22:35,920 Speaker 1: of the other things that were going on at the time, 392 00:22:36,240 --> 00:22:39,280 Speaker 1: whether she was discredited as miss instead of doctor because 393 00:22:39,280 --> 00:22:43,240 Speaker 1: she was a woman. Yeah, So that's a mystery that 394 00:22:43,280 --> 00:22:46,600 Speaker 1: remains to be solved. In the meantime, I think you 395 00:22:46,640 --> 00:22:49,480 Speaker 1: might have listener mail for us. I do have listener mail. 396 00:22:49,520 --> 00:22:54,120 Speaker 1: This is another listener mail from our Brown Versus Board series, uh, 397 00:22:54,160 --> 00:22:58,320 Speaker 1: and it is from Gia. Gia says, I recently listened 398 00:22:58,320 --> 00:23:00,879 Speaker 1: to Your Brown Versus Board of Education and found the 399 00:23:00,920 --> 00:23:04,639 Speaker 1: aftermath episode fascinating. I grew up in downtown Boston, and 400 00:23:04,640 --> 00:23:07,080 Speaker 1: even though I was born in the early eighties, people 401 00:23:07,119 --> 00:23:10,320 Speaker 1: were still talking about bussing in the nineties and early 402 00:23:10,320 --> 00:23:13,480 Speaker 1: two thousands. In Horror, Boston is set up in a 403 00:23:13,520 --> 00:23:16,280 Speaker 1: series of small neighborhoods which were once full of families 404 00:23:16,280 --> 00:23:19,320 Speaker 1: and children. Was very common for people, especially children and 405 00:23:19,359 --> 00:23:22,919 Speaker 1: their mothers, to live their lives wholly in their neighborhood. 406 00:23:23,359 --> 00:23:26,960 Speaker 1: My grandmother raised four children, worked, shopped, and socialized in 407 00:23:27,000 --> 00:23:30,040 Speaker 1: a one square mile piece of Boston, and back then 408 00:23:30,040 --> 00:23:33,560 Speaker 1: that was completely normal. The people of these neighborhoods had 409 00:23:33,560 --> 00:23:37,879 Speaker 1: neighborhood pride, and until pretty recently, residents were incredibly territorial. 410 00:23:38,320 --> 00:23:40,960 Speaker 1: Black people were chased out of white neighborhoods for not belonging, 411 00:23:41,280 --> 00:23:44,200 Speaker 1: but so too were white people chased out of black neighborhoods. 412 00:23:44,440 --> 00:23:47,680 Speaker 1: In four I was chased out of an Irish neighborhood 413 00:23:47,760 --> 00:23:50,800 Speaker 1: two blocks from my Italian neighborhood because I didn't belong there. 414 00:23:51,560 --> 00:23:54,240 Speaker 1: Boston was not immune to racial tensions. But the thing 415 00:23:54,359 --> 00:23:56,960 Speaker 1: I was still hearing about in nineteen ninety six was 416 00:23:57,000 --> 00:23:59,280 Speaker 1: the horror of having to take a bus with strangers 417 00:23:59,280 --> 00:24:01,320 Speaker 1: to a neighborhood far from home, to sit in a 418 00:24:01,400 --> 00:24:04,639 Speaker 1: strange school with more strange kids who were from a 419 00:24:04,640 --> 00:24:08,320 Speaker 1: completely different culture. My family lived in the Italian section 420 00:24:08,320 --> 00:24:11,440 Speaker 1: of Boston, and my mother didn't meet someone who wasn't Italian, 421 00:24:11,680 --> 00:24:15,080 Speaker 1: maybe Irish and Catholic until she was fifteen years old. 422 00:24:15,760 --> 00:24:17,560 Speaker 1: The prospect of having to go on a bus full 423 00:24:17,560 --> 00:24:19,840 Speaker 1: of strangers to a neighborhood where she was not welcome 424 00:24:19,920 --> 00:24:21,240 Speaker 1: to be one of the few white kids in a 425 00:24:21,320 --> 00:24:25,160 Speaker 1: predominantly back black school. This idea was daunting. Not to mention, 426 00:24:25,240 --> 00:24:27,800 Speaker 1: immigrants in my neighborhood didn't want their daughters so far 427 00:24:27,880 --> 00:24:31,440 Speaker 1: from home. A cultural thing. Many of my mother's schoolmates 428 00:24:31,640 --> 00:24:33,720 Speaker 1: were sent to Catholic school to avoid the need to 429 00:24:33,760 --> 00:24:36,879 Speaker 1: move or the need to bus. The Catholic schools were overrun. 430 00:24:37,440 --> 00:24:40,160 Speaker 1: She goes on to talk about a more personal story 431 00:24:40,200 --> 00:24:42,480 Speaker 1: about integration at her own school, which I'm not going 432 00:24:42,520 --> 00:24:44,320 Speaker 1: to go into detail about because I feel like that's 433 00:24:44,320 --> 00:24:47,120 Speaker 1: a little bit too much identifying information to go on here. 434 00:24:47,280 --> 00:24:50,800 Speaker 1: But um, She ends by saying that now when she 435 00:24:50,800 --> 00:24:53,080 Speaker 1: goes back to alma mater, to her alma mater, the 436 00:24:53,119 --> 00:24:55,199 Speaker 1: halls seemed more and more colorful, which I thought was 437 00:24:55,200 --> 00:24:58,320 Speaker 1: a good note to end on. Uh. I spent a 438 00:24:58,320 --> 00:25:01,479 Speaker 1: lot of time in Boston. If you walk around Boston, 439 00:25:01,520 --> 00:25:05,600 Speaker 1: you can still still see, uh, really clear hallmarks of 440 00:25:06,040 --> 00:25:09,359 Speaker 1: the different cultures that settled different parts of Boston. Like 441 00:25:09,400 --> 00:25:12,679 Speaker 1: they're very clear. This this used to be an entirely 442 00:25:12,720 --> 00:25:15,080 Speaker 1: Italian neighborhood, and in a lot of cases it's still 443 00:25:15,119 --> 00:25:21,480 Speaker 1: predominantly in an Italian neighborhood. But I had not realized 444 00:25:21,840 --> 00:25:25,760 Speaker 1: how deeply those community ties ran. And then it was 445 00:25:25,800 --> 00:25:29,600 Speaker 1: to the extent that like this little insular, insular neighborhood 446 00:25:30,119 --> 00:25:33,879 Speaker 1: was its own little thing that people were very protective 447 00:25:33,880 --> 00:25:37,160 Speaker 1: of without seeing it in the greater context of Boston 448 00:25:37,680 --> 00:25:40,479 Speaker 1: as a whole, which I think probably most people not 449 00:25:40,600 --> 00:25:47,040 Speaker 1: from Boston think of Boston and also probably Cambridge as 450 00:25:47,160 --> 00:25:51,199 Speaker 1: a thing, uh, even though there are lots of different 451 00:25:51,240 --> 00:25:54,919 Speaker 1: insular communities all around the area. So thank you for 452 00:25:54,960 --> 00:25:57,120 Speaker 1: sending us that note. 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