The Population as Patient

In early 1956, Alice Stewart, a 50-year-old doctor and assistant director of the Institute of Social Medicine at Oxford, visited the first of 203 local public health departments she would call on that year. Travelling by train and funded by a £1000 grant from the Lady Tata Memorial Fund for Leukaemia Research, she was seeking cooperation in carrying out a survey designed to investigate the causes of leukaemia. The Oxford Survey of Childhood Cancers, as the project would come to be known, had been prompted by a 1955 paper by her colleague, David Hewitt, at the Oxford Centre for Social Medicine that indicated a startling rise in leukaemia rates in developed countries. Hewitt had shown that the chances of a newborn male dying of leukaemia had nearly tripled between 1930 and 1955. Deaths from leukaemia, though a small proportion of total deaths, were noteworthy because, as Hewitt put it, “the years of potential life lost by death from leukaemia were disproportionately great”. ¹ In other words, many children were dying from leukaemia, especially children between two and four years old, an age when children were traditionally less likely to perish from malignant disease. The rate of increase of leukaemia deaths was also striking, outpacing all other causes of death save lung cancer and coronary thrombosis. This finding was statistically very unusual. As Hewitt put it, “This abrupt, upward change in mortality has no parallel in any other cause of death for which statistics are available… This phenomenon appears…to have become more important during recent years.” ²