Dr. Alice Stewart: The Radiation Epidemiologist (Part I)

In this two part series, Aarati tells the story of the epidemiologist who realized there was a link between prenatal x-rays and childhood cancer. She  undertook a lifelong crusade to warn people against the dangers of radiation.

Transcript

Aarati Asundi (00:12)
Hi everyone, and welcome back to the Smart Tea Podcast where we talk about the lives of scientists and innovators who shaped the world. I'm Aarati.

Jyoti Asundi (00:21)
I'm her mom Jyoti.

Aarati Asundi (00:22)
And it's March, so it is Women's Month. And traditionally on the podcast, we like to do women scientists for Women's Month.

Jyoti Asundi (00:33)
Girl power, yes.

Aarati Asundi (00:35)
And so I remembered a couple of months ago, I was in the bio section of the library, killing time and a book caught my eye. The title of the book was The Woman Who Knew Too Much.

Jyoti Asundi (00:51)
Ooh! Play off on Alfred Hitchcock's most famous movie, The Man Who Knew Too Much.

Aarati Asundi (00:57)
Exactly. And so that's why it caught my eye.

Jyoti Asundi (00:59)
Wow, so is this another suspense thriller? Oh my goodness!

Aarati Asundi (01:04)Yeah, so I looked at it really quickly and the tagline on the book said Alice Stewart and the secrets of radiation by Gayle Greene.

Jyoti Asundi (01:13)
Oh goodness! Okay, okay.

Aarati Asundi (01:14)
Yes. And so was like, ooh, radiation, that's a big topic. 

Jyoti Asundi (01:19)
Yes.

Aarati Asundi (01:19)
I'm going to just log that away. I put her on my list as a, you know, to be read, to be done. And so with March coming around, I was like, ⁓ I remember that book, The Woman Who Knew Too Much. Let's do a dive into so I started reading this book. It's an amazing biography written by Gayle Greene. And she actually went and spent time with Alice Stewart and wrote down her entire life story.

Jyoti Asundi (01:48)
Oh a first hand... Nice.

Aarati Asundi (01:51)
Yes. So she spent a lot of time interviewing, wrote this huge book. And so I'm reading this book. It's incredible. And there's 18 chapters. And by the time I got to chapter seven, Alice Stewart had retired. And so...

Jyoti Asundi (02:11)
Oh so after she retires, there is... she has done so much that the author needed another 11 chapters to...

Aarati Asundi (02:21)
Yes. And so I was taking notes on the side for the episode, like while I'm reading this and I'm looking at the length of my notes and I'm like, this is, this is going to be a two parter. It's, it's got to be.

Jyoti Asundi (02:31)
Absolutely. You need to do justice So you have all of March to talk about this amazing lady.

Aarati Asundi (02:38)
Yes. March is going to be dedicated to Alice Stewart or Alice Mary Stewart.

Jyoti Asundi (02:45)
Nice. That's wonderful. You've got me all excited, especially with the fantastic title, The Woman Who Knew Too Much. Let's see how it is that she knew too much. Why is it?

Aarati Asundi (02:56)
Yeah, well, clearly she did because it took 18 chapters, plus more probably to get her entire story written down.

Jyoti Asundi (03:04)
Fantastic. I am so looking forward to this episode.

Aarati Asundi (03:08)
So let's get into it. So Alice's story actually really starts with her parents, Lucy and Albert Naish. Both Lucy and Albert were doctors, which given that this is the late 1800s that this is happening in, it's pretty incredible that Lucy, the mother, also managed to become a doctor.

Jyoti Asundi (03:29)
Yes, very unusual situation.

Aarati Asundi (03:32)
Yes. So Lucy had gone to the London School of Medicine for Women, which had been set up by Elizabeth Garrett and Elizabeth Blackwell, who were the first two women in Britain who were formally recognized as doctors.

Jyoti Asundi (03:47)
Yes, yes, I think we have mentioned these in some other episodes.

Aarati Asundi (03:52)
Elizabeth Blackwell is definitely on my list of to-be-done episodes.

Jyoti Asundi (03:56)
Yes, pioneer ladies.

Aarati Asundi (03:58)
Yeah. So this women's school of medicine that they set up was part of the Royal Free Hospital, which largely catered to very poor patients who couldn't afford to go anywhere else. While she's doing her surgical training, Lucy met Albert, who was a doctor from Cambridge. Lucy was immediately smitten and rearranged her schedule to make sure that whenever Albert was on duty, she also just happened to be doing her surgical assistance training at the same time.

Jyoti Asundi (04:30)
Smart lady all around.

Aarati Asundi (04:31)
And evidently that worked because six weeks after she graduated, she and Albert were married. 

Jyoti Asundi (04:38)
All right.

Aarati Asundi (04:39)
They initially tried to set up a practice together in Yorkshire as part of a bigger clinic, but when they put both of their nameplates on the door, the senior member of the practice said he would not allow a woman doctor to taint practice. Yeah.

Jyoti Asundi (04:53)
Ooh! Wow! I mean she's a doctor and everything and yet facing prejudice.

Aarati Asundi (04:59)
And Albert was outraged at this, that his wife would be treated in such a manner. And so they packed everything up and they moved to Sheffield, which was a bit more industrial, kind of a less upscale city than Yorkshire was. And Albert used his own money to set up a small practice for the both of them. 

Jyoti Asundi (05:20)
Good for them.

Aarati Asundi (05:21)
Yeah. So at the time infant mortality was a really big problem. New mothers often didn't know how to take care of their babies. And if they managed to gather up the courage to ask a male doctor questions post-birth, aftercare, feeding the baby, things like that, they were often dismissed as like, that's not an important question or.

Jyoti Asundi (05:45)
Of course, yes, yes, there was a lot of prejudice. Even until very recently. ⁓ I grew up in India and I have seen articles where male gynecologists were extremely of their own women patients. There was one article, I won't forget it easily and male doctor was quoted as saying labor pains as a woman gives birth is basically hysteria. ⁓ It's all in the mind. who's been conditioned to think that she should be in pain and therefore starts feeling the pain. 

Aarati Asundi (06:22)
Oh my God.

Jyoti Asundi (06:22)
And it's actually a myth.

Aarati Asundi (06:24)
As if they know anything about it.

Jyoti Asundi (06:26)
Yes. Exactly.

Aarati Asundi (06:28)
Have you seen those videos where they hook up men to like pregnancy stimulators and like...

Jyoti Asundi (06:34)
Yes, yes, I think there should be a rule they should hook up any male doctor who wanting to cater to female patients should be hooked up to these machines...

Aarati Asundi (06:45)
Definitely.

Jyoti Asundi (06:45)
....to get that sense of empathy. Like, look, this is what your patients are dealing with. You will face this in real life. So please, have this experience so you go into the clinical room with more empathy.

Aarati Asundi (07:00)
Yeah, I think they do that with police officers actually. They shoot them with a taser so that they know how painful that is.

Jyoti Asundi (07:07)
How bad it is.

Aarati Asundi (07:11)
Yeah, but like I mean especially with women also having to ask a male doctor about you know things that have happened after pregnancy and feeding their child. often very delicate kind of private sensitive questions. 

Jyoti Asundi (07:23)
Yes, it's a very private matter. 

Aarati Asundi (07:26)
Yeah, and so they may not feel comfortable. Yeah, and then

Jyoti Asundi (07:29)
I agree. I agree. It's not easy for a woman to talk about such private intimate details with a male doctor.

Aarati Asundi (07:37)
Yeah, and then to just be dismissed and be like, that's normal, or like, don't worry about that. You're making a big deal out of nothing. It's like, you know, people feel like...

Jyoti Asundi (07:43)
Yes, you should know or even or even condescension like you should know about this. What kind of a woman are you if you don't know simple things that should be like instinct in every woman should have a natural instinct on how to nourish a child. And if you don't know that what kind of a woman can you call yourself to be? Yeah.

Aarati Asundi (08:03)
Yeah. And so then because of this, babies are dying because mothers don't know how to properly take care of them.

Jyoti Asundi (08:11)
Terrible.

Aarati Asundi (08:11)
And so Lucy and Albert set up the first infant welfare clinic and they gave out free milk. And part of the condition of getting that milk was that the mothers had to attend clinics teaching them how to properly take care of themselves and take care of their babies.

Jyoti Asundi (08:30)
Yeah, yeah, even basic hygiene sometimes is the you have to take care. Otherwise are so many diseases going around and the little ones just, you know, succumbs so easily. Basic hygiene would go a long way to preventing infant mortality.

Aarati Asundi (08:46)
One of the clinics that Lucy apparently taught was how to blow your nose properly. She taught that to children.

Jyoti Asundi (08:53)
⁓ yes, yes.

Aarati Asundi (08:54)
And as you can imagine, the children all thought this was hilarious. And she really leaned into the theatrics of it.

Jyoti Asundi (09:03)
Of course, to make it more fun for them so that they get the job done right.

Aarati Asundi (09:08)
Yes. And so Lucy had this kind of bedside manner where she's very approachable, she's very friendly, full of humor and so people were willing to come to her with questions.

Jyoti Asundi (09:20)
Yes, what a gift.

Aarati Asundi (09:22)
Albert on the other Albert on the other hand was a lot shyer, a lot quieter, but they made a really good team. In her biography, Alice says, "With her organizational ability and his professional know-how, they were a powerful pair. He was up on all the new developments, particularly from abroad but she was the one who knew how to get things done."

Jyoti Asundi (09:44)
Yes, and be that bridge between the knowledge and the people who actually need to get that knowledge. Fantastic.

Aarati Asundi (09:51)
Yes. Lucy and Albert then started their own family. Alice was their third child and she was born on October 4th, 1906. They had eight children total, four of whom ended up becoming doctors themselves, including Alice.

Jyoti Asundi (10:08)
What a power couple!

Aarati Asundi (10:13)
But with both of her parents being practicing doctors, Alice and her siblings were often left to kind of fend for themselves and run wild. She and her siblings would go on all sorts of adventures, hiking, riding bikes, swimming. 

Jyoti Asundi (10:24)
Good days, good days.

Aarati Asundi (10:26)
Yep. And they didn't really have money for fancy clothes, so they were often dressed in clothes made from old flour sacks and sandals. But they were just having a blast because they were just messing them up anyway, who cares? Yeah.

Jyoti Asundi (10:39)
Yes, and free range kids. CPS would be called on them in today's world.

Aarati Asundi (10:45)
Actually I think a police officer was called on one of her brothers or something because he around where he shouldn't have been. And you know, they were like "This little street urchin is climbing this fence!" and it turned out to be the son of this doctor.

Jyoti Asundi (11:04)
But that's another very telling thing that the kids did not have enough money for fancy clothes, but the parents were giving away milk to the infants in the community. That is so beautiful. That an altruistic thing to do. Very, very lovely.

Aarati Asundi (11:23)
Yes. But Lucy and Albert made sure that their kids got a good education. That was their highest priority for both their sons and their daughters. For high school, Alice actually won a full scholarship to attend St. Leonard's School in Scotland, which meant she got to leave home for the first time. She was thrilled because although she did love her family, she never got quite as much attention as she wanted. And at school, she found friends who actually listened to her and laughed with her. And she was like, kind of the center of attention some of the times. So she really liked that. 
Many graduates of St. Leonard's traditionally went to Cambridge and seeing as it was Alice's father's alma mater, she also headed there for college. Women in Cambridge were still very rare and not welcome. In her first physiology class, Alice remembers walking into the lecture hall before the class. And as she started looking for a place to sit, every time she took a step, all the boys in the room would stomp their feet.

Jyoti Asundi (12:27)
Wow.

Aarati Asundi (12:28)
Yeah, so every time she stepped, was a big thud. She tried to sit down quickly, but the male students blocked her from entering any of the rows that were near the door. So she was forced to walk all the way down to the front of the lecture hall with them stomping at her the whole way. And in the front row, she found three more women and a Nigerian student. She said, "Here was my first lesson in racism and sexism. I learned all about minority groups in those few minutes. From then on, I had no illusions. I swore that day that I would never make friends with any other medical student."

Jyoti Asundi (13:11)
You know, this reminds me of the great author Chimamanda Ngozi Adichie. She came from Nigeria and she said, I became Black in America. I knew I was a woman in Nigeria with all the sexism going on, but the racism for the of course for the first time she encountered in America and that's when she recognized herself as Black.

Aarati Asundi (13:36)
Mm-hmm. sure that that was the same thing Alice faced because growing up in a family where her mother and father were both doctors and the daughters and sons were both equally educated, she probably had never really faced... Yeah.

Jyoti Asundi (13:49)
Yes, never had to face this issue ever. And here are these medical school students being so childish and bullies actually.

Aarati Asundi (14:00)
She vowed never to interact with them or make friends with them. And because of this, all of her friends at Cambridge were actually from entirely different fields of study. They were poets and photographers and mathematicians and journalists.

Jyoti Asundi (14:15)
Which is a gift by itself because you're getting such a wide view of the world.

Aarati Asundi (14:20)
Yeah. Despite this, though, she never really seriously considered leaving medicine. Science just came naturally to her, and she said, "I wasn't attracted to it because I wanted to do good works or to save the world, but because it presented really interesting problems."
Alice did her residency at the Royal Free Hospital, which is that same hospital where her mother and father met. And here she had two major awakenings. The first one was that she had thought her family had been poor because they couldn't afford pretty clothes and shoes. And her mom was always muttering about how they didn't have money. But here at the Royal Free Hospital, she really saw true poverty. There were some very heartbreaking cases young mothers who pregnant and then their family disowned them and they had absolutely no income. They had no one to turn to. There were families that were like living on top of each other all crammed into one room, ⁓ just dirt and filth everywhere. So it was really terrible.

Jyoti Asundi (15:26)
My goodness. Yeah, it's all relative. They say, right, no matter where you are in life, you will always find somebody better than you. You always find somebody who's worse off than you. And it looks like that's the kind of thing she's found out.

Aarati Asundi (15:39)
So it shocked her. But like her mother, she had really great bedside manner and she was always able to make her patients smile. So it was something that she was very good at.

Jyoti Asundi (15:49)
What a gift.

Aarati Asundi (15:51)
Her other awakening was that she finally found something in medicine that she felt that she was really good at, which was diagnosis. She said, "Diagnosis is fascinating. Here is a patient in a bed complaining of something. What on earth is causing it? It calls into play your powers of observation, your ability to read signs, pick out from history. It was a good time to be doing this. There was less by the way of tests It put more on your ingenuity. And I obviously had an appetite for it. I was powerless to cure people in most cases, but that didn't interfere with my passion for solving problems."

Jyoti Asundi (16:31)
What a curious mind and she just wants to get to the root of every problem. Because unless you know the root cause of the issue, you're not going to find the cure to begin with.

Aarati Asundi (16:43)
Yeah, and always have to keep in the back of the mind that she didn't have computers and she didn't have analysis programs that could do all of this data for her. She was doing it with a pen and a paper and collecting data, filing it.

Jyoti Asundi (16:57)
And actually go to the library, find the books, find historical evidence, It's not like you can type this into Gemini and ask Gemini, hey, what is going on?

Aarati Asundi (17:09)
Yeah. At Cambridge, Alice somehow managed to get engaged. And I say that because she herself doesn't really seem to understand how it happened. She had a friend named Katharine Stewart and she and Alice spent a lot of time together with Katharine's family. And the next thing you know, Alice found herself engaged to Katharine's brother Ludovick. 

Jyoti Asundi (17:34)
Somehow the friendship turned into something deeper.

Aarati Asundi (17:38)
Yeah, just by being together all the time. However, Alice nearly broke off the engagement several times because she knew how difficult it would be to be married and to have a career. And actually her older sister too apparently had been on the track for medicine and then gotten married and that had also killed her older sister's career. So yeah.

Jyoti Asundi (17:59)
Oh tough one.

Aarati Asundi (18:01)
Also, while she's engaged, she started having an affair with another student at Cambridge named William Empson, who was a brilliant young poet. But ultimately she cut it off because she felt like she was getting in too deep. She was like, I'm only 23 and I'm engaged and I'm having an affair and this is really complicated and I can't do this.

Jyoti Asundi (18:22)
Yes, yes this this sounds very complicated for sure yeah.

Aarati Asundi (18:27)
Yeah, so she ended the affair and she almost ended things with Ludovick too. But right around that time, Ludovick was laid off from his job and she felt that she couldn't break up with him at the same time. Yeah.

Jyoti Asundi (18:41)
Ah, Yes, timing, yes, yes. This is something many women fall into actually.

Aarati Asundi (18:48)
So ultimately she decided to get married to Ludovick and she did in June 1933, but she was determined that this marriage should not ruin her career.

Jyoti Asundi (19:00)
Correct.

Aarati Asundi (19:01)
The couple briefly spent some time in Manchester until Ludovick got a job in London teaching French at a public school called Harrow. And Alice got a job working at the London School of Hygiene and Tropical Medicine, taking blood samples and feeding test monkeys in a lab that studied blood diseases. 

Jyoti Asundi (19:20)
Okay, good place for her curiosity and for her...

Aarati Asundi (19:24)
Yeah, it's not exactly what she wants to do, but she's like, at least it's still like tangentially related to science in the medical field. So, okay. And it's not like she has a ton of options. So.

Jyoti Asundi (19:37)
But why does she not have other options?

Aarati Asundi (19:40)
Just because she's a woman and all other options are taken by men, so...

Jyoti Asundi (19:45)
Okay.

Aarati Asundi (19:46)
...people aren't really willing to give her a chance.

Jyoti Asundi (19:48)
So even if she's a doctor, a trained doctor, it doesn't matter. 

Aarati Asundi (19:53)
It doesn't matter. Yep.

Jyoti Asundi (19:53)
She's not going to be given a job, which is why her parents actually set up their own independent practice where they were in charge and they had, they were basically like attract the patients. Okay.

Aarati Asundi (20:03)
Yeah, so she was like, okay, but I don't want it to end my career. So I'll take something even if it's not perfectly what I want. But then when she came home, she was still responsible entirely for running the household. 

Jyoti Asundi (20:17)
Oh no, there the gender roles were still, the old, old paradigms still existed. 

Aarati Asundi (20:23)
Yep. She had two small children, Hughie and Anne, that she had to look after. And Ludovick, her husband, loved music, and so they were always hosting dinner parties with music or going to performances, and she kind of had to organize and take care of all of that.

Jyoti Asundi (20:40)
Wow, all the mental load of that fell onto her, Fell onto her shoulders.

Aarati Asundi (20:44)
Mm-hmm. I did read though she found some good ways to get around some stuff though. Like if people left invitations and said, come to my house for tea. She would strategically come at a time when she knew they wouldn't be there. Like on the day of a big football game or rugby game or whatever, you know, she would be like, "I came to your house, but you weren't there. Oh so sad." And it's like, of course they weren't there because they were at the big game as you knew they would be.

Jyoti Asundi (21:11)
Yes. Yeah, but still it makes me sad though, too. It just it's a little depressing to think about it. Her parents' marriage actually sounded like a very beautiful and partnership.

Aarati Asundi (21:23)
But, you know, I do have to admire that despite all of this, she did not give up her career at She was determined to continue her career and  not take a break because she knew that even if she took a break, it would be really hard to get back into it, you know... 

Jyoti Asundi (21:39)
Yes, correct.

Aarati Asundi (21:39)
...after she was finished raising her children or whatever it might be. So.

Jyoti Asundi (21:43)
That's right. That's right. Already as a woman, those are closing on her or not even opening for her. And then if she back into the field they are going to view her as a stay at home mom, and that's going to be even harder. Difficult. This is difficult.

Aarati Asundi (21:57)
Yes. So I have to admire that she stuck with it. And it did end up paying off. So in 1935, a position opened at the Royal Free Hospital for a registrar. And Alice was perfect for the job. She got it based on her previous achievements. And being a registrar put most people in line then to become a Consultant Physician.

Jyoti Asundi (22:22)
I see.

Aarati Asundi (22:33)
Which is... Alice was like, yes, I want to go, that's my next step. I want to go be a Consultant Physician. That'd be perfect. The one hitch in her plan is she hadn't taken the exam to join the Royal College of Physicians, which was kind of a basic prerequisite if you wanted to become a Consultant. So now she starts studying for this exam, which has a 20% pass rate. And she has two kids, you know, that are taking up a lot of her time.

Jyoti Asundi (22:51)
Yes. And the job as the registrar.

Aarati Asundi (22:55)
Mm-hmm. Yes. So people often had to retake the exam many times before passing. So she goes into the exam really nervous on January 1936. And afterwards, all the examinees are assembled into a hall where there is a list of the students that had passed and the students that had failed.

Jyoti Asundi (23:14)
Okay.

Aarati Asundi (23:15)
And Alice's name was not on either list.

Jyoti Asundi (23:18)
No.

Aarati Asundi (23:21)
It turns out that she had passed on the first try, but the announcement of her pass had been delayed because they had to translate the Latin exam certificate from all male pronouns to all female ones.

Jyoti Asundi (23:37)
She was the first woman to pass that one.

Aarati Asundi (23:38)
She's the first woman and only woman, yes. So they didn't have a female version of the certificate in Latin for her. Isn't that crazy? Yeah.

Jyoti Asundi (23:48)
Unbelievable times. She's a dynamo.

Aarati Asundi (23:53)
Crazy. Yeah, so now that she's taken this exam, she's allowed to become a consultant physician. Consultant physicians were very specialized positions and positions for women were very rare. 

Jyoti Asundi (24:06)
Yes.

Aarati Asundi (24:07)
But she's looking for positions and three years later she got a job at the Elizabeth Garrett Anderson Hospital.

Jyoti Asundi (24:14)
The same Elizabeth Garrett who actually started the school.

Aarati Asundi (24:17)
Who set up the school. Yeah, that her mom went to. Yes, it's all connected. All these women helping each other.

Jyoti Asundi (24:27)
Yes, we have to stand by each other because there is so much we face.

Aarati Asundi (24:32)
Mm-hmm. So she gets a position at the Elizabeth Garrett Anderson Hospital. However, this year, 1939, was also the start of World War II.

Jyoti Asundi (24:41)
Oh no. 

Aarati Asundi (24:43)
And so soon the family was forced to scatter. So Ludovick was sent to work on decoding at Bletchley Park. And that is a famous one. I don't know if you know about Alan Turing and the Enigma machine. There was a big movie about it called The Imitation Game. Yeah.

Jyoti Asundi (25:02)
Yeah, yeah, I do a little bit, but hang on, give me one second, because Ludovick is as a decoder. So he was I didn't recognize his field. 

Aarati Asundi (25:14)
Yeah, so Ludovick, you know, he was a French teacher, he's really into music, so I was like not sure why, 

Jyoti Asundi (25:20)
That's what I- yeah. Why did...?

Aarati Asundi (25:21)
But it kind of, I kind of got the sense that anyone with two brain cells was kind of sent there, like anyone who was, having some knowledge of anything and clearly he knew French and so they were like, all right, come help decode, do something for your country, you know.

Jyoti Asundi (25:34)
Oh I see. see. Hang on. Sorry. Sorry. I okay. This is- this is again the fault of the modern day where the word "code" automatically gives me like the visions of the computer code. But what decoder actually means is to kind of translate messages that are in different languages into English or whatever the word they were using. Okay, I am I am with you now.

Aarati Asundi (25:58)
But yeah, no, but I do agree it's a little confusing because it's like, wait, if you've you've watched movie The Imitation Game, it's like all these mathematicians who have come together to figure this out, you know, and I'm like, he wasn't a mathematician. He was a French teacher and a musician. But... 

Jyoti Asundi (26:14)
But it does make sense.

Aarati Asundi (26:14)
...I think they were just kind of recruiting a lot of people with different skill sets to come and help. Yeah.

Jyoti Asundi (26:19)
Yeah, it does make sense. If they wanted language translations, Yeah, it makes sense. It makes sense.

Aarati Asundi (26:24)
Yeah. So he goes off to Bletchley Park to do this. Alice's children were evacuated to Cambridge to live with Ludovick's parents. And Alice was sent to hospitals on the outskirts of London to take care of patients who had been evacuated from London's hospitals in case of air raids.

Jyoti Asundi (26:43)
Yes, yeah there is a massive need for medical help for all the injured and the sick. Oh this is a very difficult times, yes and families rendered a asunder.

Aarati Asundi (26:56)
Two years later, the war is still going on and Alice soon found herself in very high demand because as a woman with children, she was actually one of the few people who couldn't be called into service for the war. And so because of that, hospitals in the area who are very short staffed now because their whole staff has gone for the war effort, they're willing to give a job to literally anyone who has qualifications. And so... 

Jyoti Asundi (27:24)
That makes sense. 

Aarati Asundi (27:26)
...this opened doors for her.

Jyoti Asundi (27:28)
This open doors because all the men who would always take the jobs are out there fighting World War II. Got it. Okay.

Aarati Asundi (27:36)
Yes. And even women who didn't have children, who maybe deliberately didn't have children so that they could pursue their careers, they're also gone off to the help the war effort. So only women with children were excused from service. Yes. So now everyone's after her. So she manages to get a position as an assistant to Dr. Leslie Witts in the Newfield Hospital in Oxford, which normally would never have been open to woman.
Dr. Witts had been asked to look into why many people who had jobs filling munitions shells with TNT during the First World War had developed fatal jaundice and aplastic anemia. Because I guess they're trying to avoid that the second time around, you know? 

Jyoti Asundi (28:22)
Absolutely, yes,

Aarati Asundi (28:24)
So they wanted to know whether those diseases were dose-related were there particular individuals that were more susceptible to TNT poisoning.

Jyoti Asundi (28:35)
And she's absolutely the right person for the job with her instincts to ferret out the root cause of everything and dig for details, dig for information. Okay.

Aarati Asundi (28:47)
And also, by the way, side note here, I kind of did a deep dive into canary girls, which was the term for women workers who were the ones who were filling these munitions shells with TNT. 

Jyoti Asundi (29:00)
Oh no. They're actually getting jaundice because of something in there.

Aarati Asundi (29:04)
They're also turning yellow from the inside out. Yeah.

Jyoti Asundi (29:07)
Yes, correct.

Aarati Asundi (29:08)
I was just like, man, this history, this history is dark. There's this whole other rabbit hole you can go into about canary girls and all the horrible work environments that they had to face and the young girls too, like teenagers, you know?
So Alice didn't know anything about TNT at all, but she soon devised an experiment where she got about 40 undergraduate students from Oxford to volunteer to fill shells and then submit to blood screenings and other health tests.

Jyoti Asundi (29:39)
Okay.

Aarati Asundi (29:40)
They soon realized that it was in fact dose dependent and the TNT would enter the bloodstream through inhalation or through the skin and attack the bone marrow.

Jyoti Asundi (29:50)
It goes in that deep, okay, That's a pretty bad pathology. Attacking the bone marrow, does that cause cancers also then?

Aarati Asundi (29:59)
Not in the case of TNT poisoning as far as I could tell. I think it was, mostly anemia. 

Jyoti Asundi (30:05)
Killing off the blood cells because bone marrow is where the blood cells are made. So now the person will have fewer blood cells and getting anemia because of that.

Aarati Asundi (30:15)
Yes, yes. In the case of the volunteers, they were able to stop the study quickly enough that there was no lasting damage. And this was Alice's first real epidemiology study that she conducted.

Jyoti Asundi (30:28)
And she set it up as a very nice clinical trial with all the dose dependencies to be looked at, looking at the correct samples after the fact. She did a good job.

Aarati Asundi (30:39)
She also did a similar study in a factory that produced clothing that was supposed to protect against poisonous gas attacks. Workers were falling sick within a week of working at the factory, and Alice soon discovered that it was because they were using a chemical called carbon tetrachloride. And she recognized that chemical because carbon tetrachloride had been tested as a medical anesthetic but was deemed too dangerous. And so Alice was able to pinpoint that.

Jyoti Asundi (31:09)
Without any compunction, they're just using carbon tetrachloride there is no concept at this time of the fact that these chemicals can be dangerous to anybody handling it. No regulations, no OSHA.
Yeah people talk today blithely of deregulation,deregulation in order to reduce costs. They don't understand why these regulations were put in place to begin with. These are the things that happened where people were blithely playing around with chemicals job and just kind of trusting their employer to not risk their lives, I guess.

Aarati Asundi (31:48)
Yeah, that is one of the things I hope this podcast can kind of shed light on a bit is like, I'm learning so much about, you know, who came up with that rule? Why do we have that in place, you know, and ⁓ what was happening before we had that rule in place? What was going on?

Jyoti Asundi (32:04)
Correct.

Aarati Asundi (32:05)
So this became a landmark study for both Alice and Dr. Witts. Dr. Witts had her present it at the Association of Physicians, and they loved her presentation because she made the story super engaging. She told it like it was a detective story, and they were trying to find the bad guy who was making all these workers sick. And then slowly, she was able to put the clues together to pinpoint that carbon tetrachloride is culprit.

Jyoti Asundi (32:36)
Excellent communicator.

Aarati Asundi (32:37)
Yes. And it is again like that movie, The Man Who Knew Too Much, that detective story coming in, you know. 

Jyoti Asundi (32:44)
Yes.

Aarati Asundi (32:45)
She said, "I think it was more that than anything else that got me elected as a fellow of the Royal College of Physicians."

Jyoti Asundi (32:52)
That's a big honor.

Aarati Asundi (32:54)
Mm-hmm. She was the ninth woman and the first one under 40 years old to be elected as a fellow.

Jyoti Asundi (33:01)
breaking all glass ceilings.

Aarati Asundi (33:03)
So because of this work, even after the war, Alice remained in very high demand. She was one of the few people who had experience now setting up an experimental survey. She was asked to head a new Department of Occupational Health at the London hospital, and she was very tempted by this offer. But ultimately, she turned it down when a friend of hers told her that they didn't respect women and that she would run into a lot trouble professionally there.

Jyoti Asundi (33:31)
Okay, somebody gave her the heads up. And I'm sure she remembers her beginning days all the guys were stomping on the floor as she so that that would scar anybody for life. They'll remember and it's like I'm not going into situations where I face that again.

Aarati Asundi (33:47)
Yeah, not dealing with it.

Jyoti Asundi (34:49)
Yeah, I'd much rather deal with other things. Which is a great loss for the people who are doing the bullying actually. They don't realize losing great intelligent minds from joining them.

Aarati Asundi (34:01)
Yeah. Ultimately, she was offered a position with Dr. John Ryle, who basically had set up and was chair of the Institute of Social Medicine at Oxford. Social medicine aimed to understand why certain diseases were more prevalent in people of different social classes than others. So things like infant mortality, ear disease, respiratory problems, and gastric ulcers were all more common among people of the lower classes. 

Jyoti Asundi (34:30)
Which makes sense, actually.

Aarati Asundi (34:32)
Yeah. But back then, I think it was not as clear. 

Jyoti Asundi (34:35)
I see. There was not a clear link between infant mortality and nutrition and the access to healthcare and all of that.

Aarati Asundi (34:46)
I think there were some links that you could maybe make, but it's like things like the measles. Why do kids of lower class get the measles more often than kids? And they're causing that? What does the poor class child have in their environment that the upper class people don't or vice versa?

Jyoti Asundi (35:03)
Correct, the overcrowding because of poverty, all that is not being thought of. Yes.

Aarati Asundi (35:08)
Yeah. Yeah. social medicine wasn't a very popular field. A lot of people thought it was just trying to politicize medicine by bringing social class and wealth into it. 

Jyoti Asundi (35:17)
Yeah.

Aarati Asundi (35:18)
But Alice was very intrigued because she felt like now instead of diagnosing one person, social medicine would be like trying to diagnose an entire population.

Jyoti Asundi (35:27)
Yes, it's far reaching. The impact of the results will be widespread.

Aarati Asundi (35:33)
Her friends though warned her that she would essentially be committing professional suicide if she went ahead and took position. But she did anyway. She went ahead, she took the position with Dr. Ryle and became his first ever assistant.

_______________________________________________________________________________________

Aarati Asundi (35:55)
Hi everyone, Aarati here. I hope you're enjoying the podcast. If so, and you wish someone would tell your science story, I founded a science communications company called Sykom, that's S-Y-K-O-M, that can help. Sykom blends creativity with scientific accuracy to create all types of science, communications, content, including explainer videos, slide presentations, science, writing, and more. We work with academic researchers, tech companies, nonprofits, or really any scientists. To help simplify your science, check us out at sykommer.com. That's S-Y-K-O-M-M-E-R.com. Back to the story.
_______________________________________________________________________________________

Aarati Asundi (36:41)
Dr. Ryle was interested in studying children's health and had started the Oxford Children's Survey documenting children's health from ages one through five-ish. 

Jyoti Asundi (36:54)
Very young, pediatric. Okay.

Aarati Asundi (36:55)
Yeah. Alice wasn't too interested in that, but luckily Dr. Ryle was a very hands-off boss and kind of gave her free rein to look into whatever was interesting to her. So Alice gets to work looking into health issues that affected workers in different industries. And in the course of this, she discovers a huge untapped resource, which was the Civilian Medical Boards. These were records of men's basic health information that were collected during the war effort to see who would be fit for service. And since the war was over, they were actually about to destroy them. But Alice and Dr. Ryle managed to fight for them and hung on to them because they were seeing all sorts of interesting correlations. For example, many men who were painters also presented with peptic ulcers.

Jyoti Asundi (37:45)
Oh those are interesting connections.

Aarati Asundi (37:45)
Yeah, so why is that happening? Or certain industries like shoemaking seem to have higher incidences of people falling sick because men who had pre-existing medical conditions tended to do those kinds of jobs because they were less physically demanding.

Jyoti Asundi (38:05)
Ah! So the cause and effect are kind of inter-switched in that one.

Aarati Asundi (38:10)
Yeah, so none of this had been studied. And...

Jyoti Asundi (38:13)
Correct.

Aarati Asundi (38:13)
...unfortunately, although Alice and Dr. Ryle were very excited by it, not many other physicians really seemed to care, even when they published their findings. But this is what was interesting to Alice. Unfortunately, Dr. Ryle's health had been unstable even when Alice first met him, and it steadily deteriorated until in 1950, less than five years after Alice started working with him, he had a heart attack and died.

Jyoti Asundi (38:41)
That's sad.

Aarati Asundi (38:43)
Yeah, Alice was extremely sad at his loss, but she was determined to carry on his legacy. So she took over as head of the Social Medicine Institute. However, like I said, social medicine had a bad rap. And physicians were honestly like, who cares where diseases come from? Finding treatments for the disease is what's important. 

Jyoti Asundi (39:02)
We just want to fix it. Got it.

Aarati Asundi (39:05)
Yeah, like that's more important. And now that the Institute is being headed by a woman, Oxford was like, hey, we can shut down this Institute altogether. We don't need this.

Jyoti Asundi (39:15)
Wow, good thoughts.

Aarati Asundi (39:17)
Yeah. 

Jyoti Asundi (39:18)
I'm being sarcastic if somebody doesn't get it.

Aarati Asundi (39:21)
Yeah. So they tried shutting it down, except they forgot that Alice had tenure. So she couldn't just be kicked out. And the Institute still had living benefactor who was making large donations. So shutting it down would be a slap in the face for that benefactor.

Jyoti Asundi (39:37)
Of the benefactor. At least there was some consideration there that...

Aarati Asundi (39:41)
Yeah, there's something.

Jyoti Asundi (39:42)
"Oh wait a second we are turning off this money spigot."

Aarati Asundi (39:46)
So instead of shutting it down completely, they converted it into a much smaller unit and made Alice the head of that unit. It was a much lower paying job and they gave Alice barely any money or any research space.

Jyoti Asundi (39:59)
Hoping she'll resign on her own because you know...

Aarati Asundi (40:02)
Exactly.

Jyoti Asundi (40:02)
...we have given you tenure, we can't take that away. So we'll make life as horrible for you as possible so that you quit.

Aarati Asundi (40:09)
Yes. Or just, we don't even have to think about you. And you're just not worth our consideration. just, I don't know. You can hang on here until you retire, I suppose. But don't expect any help from us.

Jyoti Asundi (40:22)
Yes.

Aarati Asundi (40:23)
Around the same time, Alice's marriage to Ludovick also fell apart. So after the war, Ludovick did not want to move to Oxford where Alice was working. And in fact, he had met another girl while he was doing his decoding work. Alice also by now had gotten a real taste for being independent, and she was not willing to give up her work just to be with Ludovick wherever he was.

Jyoti Asundi (40:46)
Yes. Yeah.

Aarati Asundi (40:47)
So they ended up getting a divorce in 1952.

Jyoti Asundi (40:51)
Okay. The kids must be older by now though.

Aarati Asundi (40:54)
Yeah, I think so. Alice got sole custody of their children. So they were still dependent on her, but I think they were almost, you know, they were probably teenagers by this time. 

Jyoti Asundi (41:06)
At least. Yes.

Aarati Asundi (41:07)
Yeah. That same year though, Alice got back in touch with her old flame, William Empson.

Jyoti Asundi (41:12)
Oh the one with whom she had an affair before she married Ludowick.

Aarati Asundi (41:16)
Yep. They picked up the relationship right where they had left off more than 20 years ago. He too had gotten married and had two children and then separated. He had become a well-reputed poet and author. And at one point, Alice and William did consider getting married. But then William's wife came back in the picture with two children from her own affair. So it's all like really messy.

Jyoti Asundi (41:41)
It's highly complex.

Aarati Asundi (41:42)
It's very complicated.

Jyoti Asundi (41:43)
It's very complex. 

Aarati Asundi (41:45)
Yeah, was I was just like, oh my god, you know, like there's- there's just so much going on.

Jyoti Asundi (41:50)
I thought this kind of stuff happened only in very high but I guess it's more prevalent than I thought. 

Aarati Asundi (41:55)
Or like celebrity drama, like that kind of thing, yeah.

Jyoti Asundi (41:58)
Exactly. Exactly. You know, like Charles and Diana and then Charles is off with the
whatever her name is, Camilla. And then Camilla is actually married to somebody else. then, but that guy had another girl on the side too. And it's just like this. Oh my God. You're all in a web and all interconnected I can't keep it straight.

Aarati Asundi (42:19)
But again, I find it refreshing that it's like, yeah scientists and doctors, they also get equally messy sometimes. 

Jyoti Asundi (42:26)
Yeah, very messy emotions getting in the way of life.

Aarati Asundi (42:30)
Yes. So in the end William ended up staying with his wife and her children, but William continued to meet with Alice until his death in 1984.

Jyoti Asundi (42:40)
Okay.

Aarati Asundi (42:42)
Back to Alice's work, though. Alice is coming off the death of Dr. Ryle her mentor, and she's determined to carry on his legacy. So although she hadn't been very interested in in the beginning, she took over that child's health survey that he had been conducting. But she didn't have any money for research now because Oxford had basically cut her off. So she had to rely on outside funding if she wanted to get any research projects going.

Jyoti Asundi (43:11)
Yeah. 

Aarati Asundi (43:12)
So she put together a small team of a young statistician, David Hewitt, and another woman, Josephine Webb, who had worked for the Medical Research Council and was very close to retirement. They called themselves the Three Musketeers and they got to work looking for a project that would be of enough interest to attract grant funding.

Jyoti Asundi (43:34)
Yes, correct. Money is important.

Aarati Asundi (43:37)
They settled on the problem of childhood leukemia, which was on the rise, but no one was studying why. It also happened that one of Alice's good friends had a daughter who died of leukemia at age three. And so it was a very personal problem to Alice as well.

Jyoti Asundi (43:54)
Absolutely that is heartbreaking.

Aarati Asundi (43:56)
As they started looking into this, they found that children developed a specific type of leukemia called lymphatic leukemia, which affects your lymphocytes, which are the white blood cells that are part of your immune system. Interestingly, they found that children from areas with better access to medical care were more likely to develop leukemia.

Jyoti Asundi (44:18)
That's an interesting paradigm. Okay.

Aarati Asundi (44:20)
Yeah. So they were like, we need to look into why. Why is that the case? So here's where Alice has a brilliant idea. They found this pattern by looking at data from the children's medical records, which were obviously written by the doctors who had examined the children. But Alice said, let's go interview the mothers. They might have a memory of something prenatal that the doctors might have forgotten.

Jyoti Asundi (44:45)
Yes.

Aarati Asundi (44:46)
And she made this kind of intuitive leap that instead of leukemia being caused by something in the child's environment after birth, as most diseases were, maybe the cause had happened during pregnancy. So let's look earlier than birth. 

Jyoti Asundi (45:01)
Earlier much earlier yes

Aarati Asundi (45:04)
So the three of them developed a questionnaire and took it to the medical research committee to request funding for the project. They were rejected flat out, but then one doctor on the committee approached her and said he could give her 1,000 pounds from the Lady Tata Memorial Fund for Leukemia Research. So it wasn't much, but it was better than nothing. So Alice decided to go back to her birthplace, Sheffield, where she and her family were still very well known, and she could rely on the help of local physicians like one Dr. Roberts.
Dr. Roberts helped her get the survey started in Sheffield and then made introductions to public health officers in other areas so she could send the survey to them. And so slowly she grew this network all over the country and she used that thousand pound grant to pay her way and train tickets, going and convincing public health officials to collect responses to this survey and send them back to her.

Jyoti Asundi (46:07)
A grassroots movement.

Aarati Asundi (46:09)
Absolutely.

Jyoti Asundi (46:10)
She absolutely built it from the ground up. Determined lady.

Aarati Asundi (46:15)
Yes. And this questionnaire really was all-inclusive. You know, it asked the mothers about exposure to everything: different foods, aerosols, dyes, animals, infections, just, you know, anything that she could think of.

Jyoti Asundi (46:34)
Yes.

Aarati Asundi (46:35)
But within getting the first 35 responses so very, very early on, Alice saw a clear pattern that many times when a child had died of leukemia, the mother had had an obstetric X-ray, whereas in the control groups where the child had lived, the mother had not had an X-ray.

Jyoti Asundi (46:56)
Wow, we know that obviously, I mean, it is a glaring thing right now where a woman is not exposed to she's pregnant. What a... It's like in your face kind of problem.

Aarati Asundi (47:14)
Like now it's such a big, like "They were getting X-rays?! What is wrong with these people", you know? 

Jyoti Asundi (47:20)
What's wrong with them? Yes.

Aarati Asundi (47:22)
But back then, she knew that people would challenge her on it. She saw this pattern and she was like, already she was like, uh-oh, this is going to be a big battle because first of all, it's such a small dose of radiation. So it's not like a chronic exposure to something. And doctors are using it, and doctors are saying it's safe.

Jyoti Asundi (47:46)
And doctors are making money off of this from rich people who want to make sure that their kids are okay and are actually hurting the baby in the process.

Aarati Asundi (47:55)
Yes. And sure enough, when they finally published the preliminary findings in The Lancet in 1956, the whole medical community, especially obstetrics, were like, how dare you say this?

Jyoti Asundi (48:07)
Up in arms. Up in arms.

Aarati Asundi (48:09)
Yes. You're accusing us of using a tool that harms people when we are doctors and we're in the business of curing people and preventing diseases. So how dare you say that? That we would be hurting anybody. And also, X-rays were considered very safe. They were being used for all sorts of purposes back then. For example, if you went to the shoe store, they would take an X-ray of your foot so that they could see how the foot was sitting inside the shoe. So just randomly, it's rampant. 

Jyoti Asundi (48:42)
I did not know, I did not know they would use x-rays for random things like this. It is with such respect now, use only as needed because the cumulative effects are there. I'm just shaking my head in disbelief. I'm sorry, I'm unable to even process my thoughts. There is such an obvious, duh, how stupid can you get? That kind of feeling I'm having. And that they casually threw around this mighty weapon of an X-ray for random things like shoe fittings. Such a big no-no. It's shocking to me that these kind of things actually happened.

Aarati Asundi (49:28)
Yeah, I know. I recently went to the dentist and they took x-rays of my teeth and they put this lead jacket that they put on you to kind of...

Jyoti Asundi (49:36)
Protective jacket. Yes

Aarati Asundi (49:38)
Yeah. And then the x-ray itself is like two seconds. But even that, I'm just like, do I really have to do this? I guess I have to for the health of my teeth. 

Jyoti Asundi (49:45)
Yes, yes, I guess I have to so that I have my teeth for longer. Yeah.

Aarati Asundi (49:49)
But I was in the middle of reading this story and I was like, can we not do this actually right now? 

Jyoti Asundi (49:55)
Yes, yes.

Aarati Asundi (49:56)
Yeah. So she continued to collect answers to their questionnaire. And by 1958, they had published a full report in the British Medical Journal showing that a fetus that was exposed to x-ray radiation was two times more likely to develop childhood cancer, not just leukemia, but any cancer.

Jyoti Asundi (50:16)
Any cancer. 

Aarati Asundi (50:18)
And ironically, because these children had better access to health care, not only did they have that x-ray exposure to begin with that, you know, poor children might not, but also they were not dying of other illnesses like measles or whooping cough because they could take medicine for that in the first place or they weren't exposed to that. And so they were actually living long enough to develop leukemia in the first place. Although her initial paper had received some pushback, she did have actually a fair amount of people who believed and supported her. Also remember that this is happening against the backdrop of the end of World War II. We remember how World War II ended.

Jyoti Asundi (50:58)
The atomic bomb.

Aarati Asundi (50:59)
Yeah. People saw the awesome power of these nuclear bombs. And so there's like this big arms race going on, but you know...

Jyoti Asundi (51:09)
Yes.

Aarati Asundi (51:09)
...clearly the bombs that dropped and leveled the cities of Hiroshima and Nagasaki were clearly very harmful. And so for many people, it was reasonable to say, oh, OK, radiation is causing leukemia in children. I can understand why because these bombs were a huge blast of radiation. A smaller bit of radiation may also have some negative effects so she did have some supporters.

Jyoti Asundi (51:36)
And that too in a very small vulnerable child. That is- the scale is very different. A small amount a lot of harm actually. It doesn't have to be atomic bomb levels to cause harm in a small child.

Aarati Asundi (51:49)
Mm-hmm. So she did have some supporters who were like, we're on board with this.

Jyoti Asundi (51:53)
Yes.

Aarati Asundi (51:54)
But then in 1960, three scientists, Richard Doll, William Court Brown, and A. Bradford Hill came out with a study that basically said that there was a threshold at which radiation exposure became safe. And while nuclear bombs were clearly dangerous, X-rays were way below the dangerous threshold. 

Jyoti Asundi (52:15)
Okay.

Aarati Asundi (52:16)
Their study was very poorly carried out and years later even one of the authors, Richard Doll, admitted that his survey was not very good and the results were unreliable because they had used such a small population that they surveyed over a very short period of time as compared to Alice's survey that comprised of thousands of people all over the country, went really deep back into their history and followed child's health through birth and well into childhood.

Jyoti Asundi (52:45)
This is so reminiscent to me that guy Andrew Wakefield, who had single vaccine for one of the three in the MMR. He had, there is ⁓ a rubella, measles and mumps, I think.

Aarati Asundi (52:59)
Mumps. Yeah.

Jyoti Asundi (53:00)
Mumps, yeah. And it's usually given as a triple shot. But this guy, he had a single vaccine for one of these. And he wanted to drive up the sales of that. And why would people take one single vaccine instead of taking all three at the same time and being done with it? You go to the doctor, get one shot, you're against three diseases and you're done. You come back home, you're done. Instead of going one at a time. he set up a very poorly designed studies and wrote a poorly written paper on how the MMR causes autism and how vaccines given together, if you give vaccines together, then the child develops autism later. 

Aarati Asundi (53:45)
And now we're still facing those repercussions.

Jyoti Asundi (53:47)
We are still fighting that. We are still fighting that. So people with like personal interests, kind of skew the whole thing with enough loud voices, enough megaphones because they have the money, they are able to skew the thing all the way. 

Aarati Asundi (54:04)
And that's exactly what happened here. Like this paper that he put out saying that there is a threshold at which radiation is safe...

Jyoti Asundi (54:12)
...is safe. Yeah.

Aarati Asundi (54:13)
...that really took deep hold. A lot of people believed that. A lot of people were that makes sense. Yeah, bomb is going to be dangerous, but there is going to be a threshold at which we're okay. So Richard Doll, he's a giant in his field. So in 1956, he had established that smoking increases the risk of lung cancer. that's like this huge link that he's created. And so people are applauding him. 

Jyoti Asundi (54:39)
Yeah, so he has established credibility.

Aarati Asundi (54:43)
Yes. And he was even knighted in 1971. So he's getting all these accolades, whereas Alice, on the other hand, her findings are ignored for many decades. Many people don't believe her, and she's not getting funding for her work from Oxford. Oxford's cut her off. So she's just struggling here, even though she's made this equally important finding and contribution.

Jyoti Asundi (55:11)
What a loss for humanity. 

Aarati Asundi (55:12)
I know.

Jyoti Asundi (55:12)
So many children suffered for no reason.

Aarati Asundi (55:15)
Luckily though, a visiting scientist told her that she should try applying to American Institutes for funding instead. And she was actually successful in getting grants from the National Cancer Institute and various leukemia foundations for her work.

Jyoti Asundi (55:28)
Okay. 

Aarati Asundi (55:29)
It was actually a well-respected American physicist, Dr. Carl Morgan, who had worked on the atomic bomb, who saw Alice's work and drew attention to it, saying, "As she collected more and more data, it has become evident that there is no safe level of radiation".

Jyoti Asundi (55:47)
Yes. Good.

Aarati Asundi (55:49)
But despite this, it took until 1980 before American hospitals stopped routinely x-raying pregnant women and then slowly the ultrasound replaced X-rays.

Jyoti Asundi (56:03)
20 more years, a little over two decades after knowing this critical information, people continued onto that wrong path of X-raying fetuses. Tragic.

Aarati Asundi (56:15)
Yeah. And even then it was like in 1980, American hospitals stopped recommending it, but they ban it. They didn't say stop doing it. You know, they were just like, okay, it's no longer like part of the routine. You can still have it done though. So it's like, oh my God.

Jyoti Asundi (56:33)
This is something we know so clearly now. It is incredible that people just did this willy-nilly.

Aarati Asundi (56:40)
Yeah. So over the years, Alice had built a ragtag team of random people to help with the study, many of whom were retired or students or just needed something temporary. So Oxford was just, you know, mainly trying to pretend that the Social Medicine Unit didn't exist. So she just found kind of like random people to help out anyone who any sort of skill. And it could even just be like, hey, you go talk to the people and get them to fill out this questionnaire and bring me back the data. You don't need much skills for that. Go do that. You know, anybody anybody come help.

Jyoti Asundi (57:16)
Yes.

Aarati Asundi (57:18)
So because they were ignoring her, she could basically do whatever she wanted, even though she didn't have a lot of money with which to do it.

Jyoti Asundi (57:27)
Yeah. Yeah.

Aarati Asundi (57:28)
She was basically able to carry out whatever study she wanted and go in whichever direction she wanted.

Jyoti Asundi (57:33)
Yeah, yeah.

Aarati Asundi (57:57)
By this time, Alice had also become a grandmother. Her son, Hughie, had two children, Charles and Christabel. But tragically, Hughie took his own life in 1977 by overdosing on lithium.

Jyoti Asundi (57:49)
Oh that is very sad. 

Aarati Asundi (57:51)
Very hard.

Jyoti Asundi (57:52)
Very sad, very hard. This is dark man, you are going into dark places with this one.

Aarati Asundi (57:57)
Alice believes he likely succumbed to manic depression, which apparently ran in the family. But Alice had a very big heart. She supported Hughie's wife, Jeanette, by giving them a house and taking care of the children for two years while Jeanette finished up her college degree. 

Jyoti Asundi (58:15)
What a wonderful lady.

Aarati Asundi (58:17)
Very supportive. And then Alice's daughter, Anne, also had two children, Eleanor and Harriet and Alice worked very hard to make sure that all of her grandchildren were very well taken care of and put on successful paths.

Jyoti Asundi (58:31)
She's passing on the legacy that her parents created for her and her siblings. She's doing that for the next generation.

Aarati Asundi (58:39)
Yes. And just like, you know, again, balancing this all against the backdrop of her own work and her own studies. It's like she's still in there taking care of her grandchildren now. So.
In 1969, Richard Doll came to Oxford as Regis Professor. Initially, Alice was very excited because after all, they worked in very much the same field. And so she finally felt like she would have the support of somebody else and she would be able to get a professorship.

Jyoti Asundi (59:10)
But he already wrote that paper against her, right?

Aarati Asundi (59:14)
Yeah, he had written the paper, but at least even though they had that kind of professional disagreement, she respected his work with the link of, you know, smoking and lung cancer. 

Jyoti Asundi (59:24)
The smoking and cancer thing.

Aarati Asundi (59:26)
Yeah. And it's like, you're doing very much the same kind of work as I am. You think that there's a safe threshold for radiation. I do not. So we can work together on this problem. We can figure it out. She felt like, you know, finally, I'm going to have support. This guy's coming to Oxford and he's going to show people that social medicine is important. And finally, I'll get my time in the light, you know, that Oxford no longer ignore this branch of science that they've been trying to ignore because Richard Doll is here, you know,

Jyoti Asundi (59:58)
Correct.

Aarati Asundi (59:59)
But they changed the Social Medicine Unit into Preventative Medicine and made Richard Doll the chair of it. That was like a huge betrayal to Alice.

Jyoti Asundi (1:00:11)
Got it. They played the game. Yeah, I see the game they are playing.

Aarati Asundi (1:00:15)
Yeah. Alice was like, my predecessor, Dr. Ryle, had been chair of the social medicine. And then I was kind of shoved aside for decades. And then here comes Richard Doll, and he becomes chair. So...

Jyoti Asundi (1:00:30)
Correct.

Aarati Asundi (1:00:30)
I never got to be chair of anything. What is this?

Jyoti Asundi (1:00:34)
Yeah, they're making it very clear that they are sidelining her. They are putting up with her only because she has tenure and they can't do a damn thing about it. But they don't respect her. They don't trust her judgment. 

Aarati Asundi (1:00:47)
And she was also upset with Richard Doll because she was like, you're coming in to Oxford in this position of extreme power and you could have, you know, said I'll defer my chairship. I'll give it to Alice for a few years because he knew that Alice was just a few years away from retirement. So he could have said you be chair until you retire and then I'll take over his chair or I'll give you a full professorship. He could have helped her with the enormous influence that he had. But according to her, he never once offered to do any of that to lend her a helping hand to come up. Although he tells a different story. He's like, I did everything in my power. She doesn't understand the politics behind all of this. But she was like, "Oh come on".

Jyoti Asundi (1:01:33)
This is very reminiscent of the previous story, Vivian Thomas, Dr. Blalock says he has done it all. He did the best he could, but it turns out that he never ever published anything with Vivian's name on it. It took other people actually to do that.

Aarati Asundi (1:01:51)
Yeah.

Jyoti Asundi (1:01:52)
Life is full of injustices like this, especially for the minorities, especially for women. And it's good thing we are highlighting this for Women's Month. 

Aarati Asundi (1:02:02)
Well, that's why we have these months, right, to shed light on people who've struggled.

Jyoti Asundi (1:02:06)
Shed...yeah. The struggles that women face for no reason.

Aarati Asundi (1:02:10)
And Gayle Greene, the author of Alice's book, put it really well. She wrote, "Alice can't shake the feeling that she's been swimming upstream against some strong invisible current all these years, and that a word from Doll might have set it all right, but that word was never spoken. It's as though he can't bear to let me into the story."

Jyoti Asundi (1:02:33)
So sad. That sentence really does encapsulate the experience of so many women. So many women feel we are constantly swimming upstream.

Aarati Asundi (1:02:45)
It was a really good metaphor. I think a lot of people will resonate with that.

Jyoti Asundi (1:02:50)
Absolutely.

Aarati Asundi (1:03:14)
And then the final kind of nail in the coffin for Alice was that years later, Oxford released a press article that said, "A unique nationwide investigation into the cancer in children is set to start on 1st April, 1992. It was to be done under the illustrious Sir Richard Doll and would cost 6 million pounds." 

Jyoti Asundi (1:03:17)
And she was not even given 1000 pounds.

Aarati Asundi (1:03:21)
Yeah, she was like, I did that study already for 1000 pounds. Like, what do you mean a unique study that's never been done before? I did that.

Jyoti Asundi (1:03:31)
So they're basically trying to pretend that this never happened, her work never happened.

Aarati Asundi (1:03:37)
Basically, yeah, they're like, this is like the first of its kind, a unique survey of children and leukemia. And she's like, hello. 

Jyoti Asundi (1:03:44)
How can they do that when she has already published?

Aarati Asundi (1:03:47)
Yeah, I know. But one interesting point, I guess, to note is that her friends did mention that she was fiercely independent and self-sufficient, and that was a strength as much as it was a weakness because she didn't try to rub elbows or socialize with, quote-unquote, the right people. And maybe if she had made more of an effort, there would have been more male allies to help her, but she was always like, I've got better things to do than dress up and go to this fancy garden party. Or I've got work, I've got kids, I've got grandkids. And so like, can't go to that conference. I can't go to that party.

Jyoti Asundi (1:04:9)
Yes, which is highly legit. Which is a very legitimate way of living. You shouldn't have to schmooze around with other people at parties in order to form allies. Your work speaks for itself. That's how it should be, especially in a place like Oxford.

Aarati Asundi (1:04:42)
But people did note that, if you're not, if you're skipping out on parties, you're skipping out on attending conferences, you're skipping out on, like, being on these committees and things like that, you're not going to make many friends. And so when things like this happen, you aren't going to have allies. And so it's not like blaming her at all. But it's just an interesting point to note that that is how...

Jyoti Asundi (1:05:03)
A recognition of the times, a recognition of all the other social factors that came into play in the fact that she did not have allies.

Aarati Asundi (1:05:12)
And it's still true today, you know. A huge part of, you know, your career is who you know, and the people who are willing to help you.

Jyoti Asundi (1:05:19)
And networking, yeah. It's not what you know, it's who you know. That's a famous statement even now.

Aarati Asundi (1:05:22)
Exactly. And unfortunately, Alice didn't know who she maybe needed to know in order to make her life a little bit easier,

Jyoti Asundi (1:05:31)
Yeah.

Aarati Asundi (1:05:33)
So when Richard Doll became chair, she was like, enough is enough. So she started making it known that she wanted to leave Oxford and that she still had funding from the American Institutes. So anyone who took her on wouldn't even have to pay her. The head of social medicine at Birmingham got wind of this and invited her to come on as a senior honorary research fellow. So Alice made arrangements for the Oxford child survey to continue and then she retired from Oxford. And that's where we're going to stop part 1 of this series for now and come back next time for part 2.

Jyoti Asundi (1:06:12)
Wow, this has been a rough journey so far. You took us through some very dark times and she's still battling the bias that people had in those days against women.

Aarati Asundi (1:06:28)
Yeah, but she's a fighter. If anyone could handle it all, Alice Stewart could handle it all. I think this really speaks to just the strength of women and what they have to put up with and the things that she was willing to put up with and fight against because she did see the bigger picture. She was like, no, I need to help prevent this horrible disease from affecting more people and the only way to do it is to battle through. So I'm going to battle through.

Jyoti Asundi (1:06:55)
She was passionate about her work. This became her calling. No money, no recognition, no fame. In fact, I can see in my mind's eye people in Oxford snickering about that eccentric old lady in that corner over there.

Aarati Asundi (1:07:08)
Oh yeah, she had a big reputation for, you know, crazy Alice Stewart. Don't listen to a word she says. She's off the rocker. Unfortunately, she has tenure though, so she can't get rid of her completely. You know, yeah, she was battling a lot of nasty remarks, but she just never let it get to her. She's just like, that's your opinion, you know? There's nothing I can do about your opinion.

Jyoti Asundi (1:07:30)
Such utter such utter disrespect for good science in a place like Oxford that is shocking.

Aarati Asundi (1:07:35)
Yeah. So yeah, we'll get to part two next time and learn what she did after retirement from Oxford.

Jyoti Asundi (1:07:44)
Which is... from the way the book has been structured where there's only seven chapters we have covered so far...

Aarati Asundi (1:08:10)
There's still a lot ahead. So stay tuned.

Jyoti Asundi (1:07:55)
It sounds fantastic. I can't wait to continue.

Aarati Asundi (1:07:59)
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