Alice Stewart: The woman who knew too much

Alice Stewart was one of Britain’s foremost epidemiologists. However her recognition came late in her career, having spent her life fighting the establishment’s enshrined views.

In the 1950s when she started her work, x-rays were routinely used in foetal monitoring. It was Stewart who first showed the link between the practice and childhood leukemia. She went on to look at the effects of low-level radiation exposure – uncovering the true adverse effects of chronic exposure, and thus earning herself the enmity of the nuclear industry.

“It was a large room, an auditorium you entered from the rear with a long set of steps descending to the speaker’s podium in the front. I slipped in, hoping to take a seat as close to the back as possible. But when I stepped into the hall and took my first steps, the students, all male, began stomping, slowly and deliberately, in time with my steps. As I took my first step into that room, bang! came the sound of two hundred men stomping their feet in unison. I took my second step and the stomp was repeated. Every step I took, there was this stomp, stomp, stomp. My first instinct was to duck into a seat and disappear, but no — every row was blocked by the men. I was forced down to the front row, where I found three other girls and a Nigerian. These medical students had managed to segregate us out — they weren’t going to have anything to do with women or minority populations. I wasn’t whipped. I was stomped.” Alice Stewart, “The Woman Who Knew Too Much, Alice Stewart and the Secrets of Radiaton” (2004)

Alice Mary Stewart
BMJ. 2002 Jul 13; 325(7355): 106.

Epidemiologist who showed that x rays in pregnancy caused childhood leukaemia and who took on the nuclear industry over safety issues

Alice Stewart, who retired aged 90 and who has died aged 95, was one of Britain’s foremost epidemiologists. She showed that x rays in pregnancy caused childhood leukaemia. She demonstrated that low level radiation was far more serious than had been officially accepted and she championed the cause of people exposed to radiation.

The daughter of two paediatricians, Lucy and Albert Naish, who worked in the Sheffield slums, Alice was the third of eight children. She inherited from both parents a commitment to the betterment of society and a willingness to sacrifice financial gain to devote herself to the prevention rather than the cure of disease.

She was one of four women to enter the Cambridge medical school along with 300 men, who stamped their feet in unison when the women entered the lecture theatre and slammed their desk lids when they sat down. Her wide cultural interests made her many friends in the humanities faculty. Her relationship with the poet William Empson lasted 60 years until his death in 1984, although she married someone else.

She went to the Royal Free Hospital, London, for her clinical training and mopped up the prizes. During the second world war she worked at the Elizabeth Garrett Anderson Hospital in London and ran an emergency clinical unit at St Albans. She then moved to the Nuffield department of clinical medicine at Oxford, where she investigated the effects of exposure to the explosive TNT (trinitrotoluene) in munitions workers, and the effects of carbon tetrachloride, and tuberculosis among footwear industry workers. Having shown her mettle, she was brought into the Oxford child health surveys.

The incidence of child leukaemias was increasing and, in 1955, it was suggested that there might be an environmental cause. Alice Stewart thought that the mothers might remember something the doctors did not, so she interviewed them and rapidly saw the correlation with x rays. Radiography was medicine’s new toy and was being used for everything from examining the position of the fetus to treating acne and menstrual disorders. It was even used in shoe shops: children loved to watch through the x ray machines while they wriggled their toes in their new shoes. This was at the height of the arms race, when the British and US governments were trying to build up public trust in the friendly atom and did not want people to get the idea that low dose radiation could kill children.

Stewart’s findings were accepted after brief resistance by health physicists but fiercely opposed by many physicists and radiobiologists, the UK National Radiation Protection Board, the International Commission for Radiation Protection (ICRP), and by the powerful nuclear lobbies. Stewart’s findings implied that low level radiation, which had become an everyday part of life for nuclear workers, the armed forces, and sometimes even the public, could be far more harmful than had been thought or admitted.

In 1974, when she was 70 and about to retire from Oxford and relocate to Birmingham University, she was contacted by Dr Thomas Mancuso, who had been appointed by the US Atomic Energy Commission to study the health of nuclear workers. Since the industry was required to work within the exposure levels laid down by the ICRP, the study was also seen as a test of these standards. The Stewart-Kneale-Mancuso analysis (George Kneale was a statistician colleague) revealed over 10 times the cancer incidence predicted from A-bomb survivor studies.

An immediate and damning official outcry ensued. Mancuso was deprived of his directorship and the use of outside consultants was banned. Their work continued despite this. Stewart further infuriated the establishment by pointing out that, until the nature of radiation damage to genes was understood at the molecular level, predictions of second generation and long term genetic effects were premature.

When it was proposed that the nuclear installation at Sellafield, Cumbria, should be expanded, Stewart assumed that the nuclear industry would be in touch. But she was wrong. She was, however, contacted by anti-nuclear groups from around the world. In her last 20 years she was in demand at conferences, hearings, and inquiries throughout England, Europe, and the United States. She testified for nuclear workers seeking compensation, for British and American veterans of atomic testing, and for women arrested protesting against cruise missiles at Greenham Common.

Alice Stewart always felt that she’d been helped more than hindered by being a woman. “If I’d been a man, I’d never have stood it—the pay was too low, the prospects too bad, I’d have had my eye on the prize.”

She married Ludovick Stewart, a languages teacher at Harrow School, in 1933; they had two children and divorced in the 1950s. Her son predeceased her; her daughter, Anne Marshall, a neuropathologist and general practitioner, survives her.

Alice Mary Stewart, epidemiologist and expert on radiation and health (b 1906; q Cambridge 1935; FRCP), d 23 June 2002.

Alice Stewart, The Woman Who Knew Too Much
Image: Alice Stewart
Alice Stewart, The Woman Who Knew Too Much 2
Image: Alice Stewart
Alice Stewart, The Woman Who Knew Too Much 3
Image: Alice Stewart


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