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September 30, 2014

Pin-pointing a pioneer in modern radiotherapy

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Pictured at a commemoration to Dr Walter Clegg Stevenson (1877-1931), pioneer in radium therapy in Ireland, was Dr Harold Brenner, who provided much of the research for the occasion on July 11, 2012 at Dr Stevenson’s former home on Baggot St. A portrait of Dr Stevenson is in the foreground

Dara Gantly was on Baggot Street recently for the official unveiling of a plaque commemorating an Irish pioneer in the field of radiation oncology.

Surgeon & Radiologist. Pioneer in Radiation Oncology.’ So reads the bronze commemorative plaque celebrating the life and work of Dr Walter Clegg Stevenson (1877-1931), who lived at 60 Lr Baggot Street — now called Carmichael House — for 21 years of his adult life.

Credited with developing the so-called ‘Dublin method’ or ‘needle method’ of radium treatment — with his collaborator and friend John Joly, Professor of Geology at TCD — Stevenson certainly deserves his place in the history of brachytherapy, but for too long the honour due to him was not forthcoming.

According to Dr Harold Brenner, who has spearheaded the erection of the plaque with the permission of the Stevenson family, for over 100 years there has been controversy over who was the first to treat cancer with radiation.

Nowadays it’s accepted that it was in France where the major breakthrough took place, when it was discovered that daily doses of radiation over several weeks greatly improved the patient’s chance for a cure. However, brachytherapy is a different matter.

Of course, such treatment was only made possible through the discovery of x-rays by Wilhelm Röntgen in 1895, after which within months, systems were being devised to use x-rays for diagnosis, and within three years radiation was used to treat cancer.

According to Prof Davis Coakley, who devoted a chapter on Stevenson in his acclaimed 1992 text Irish Masters of Medicine, within just six weeks of Röntgen’s discovery, William Steel Haughton was making his own x-rays in the basement of Sir Patrick Dun’s Hospital — such was the speed of uptake of the new technology.

Homage to the Curies
Even the most cursory examination of the use of radium, as this writer is attempting here, must pay homage to the Curies for isolating radium from pitch-blende and allowing its use as a treatment in experimental form. But it was not long before Stevenson and Joly (who incidentally was the first to use radioactivity to calculate the age of the earth, among many other contributions) brought this ground-breaking technology to Ireland. One of their earliest results, in 1910, involved the cure of a case of ‘facial rodent ulcer’ by exposure to the rays emerging from a glass tube containing a few milligrams of radium. The material — which at that time cost about £20 per milligram — had been obtained by Joly from Berlin.

But as Joly pointed out himself in an in memoriam article in the Irish Journal of Medical Science (IJMS) on Stevenson, it was in a paper presented to the Royal Dublin Society on March 1914 that the method by which “the emanation, or the parent radium, is distributed in small quantities in fine capillary glass tubes, which for application are inserted in thin-walled serum or exploring needles” was first described.

Joly acknowledged that it was believed by some that American surgeons had adopted the ‘needle method’ before Stevenson, but in the obituary he quoted Prof James Ewing of Cornell University Medical College, who wrote in 1923: “Apparently it was Stevenson of Dublin who, about 1915, first inserted coarse needles containing radium into the substance of squamous carcinoma of the mouth… He has succeeded in curing some of these cases.”

An extract from the British Medical Journal of 1914 (July 4, 1914) shows Stevenson’s use of the technique a year earlier, which proves to many — including Joly — that his colleague was indeed to first to use the undisputed ‘Dublin method’.

“It is now quite clear that Stevenson produced a method more than a year prior to its use in America and, as Prof Joly put it, his name should be forever associated with it,” Dr Brenner told the small gathering in Baggot Street for the unveiling.

Family life
Married to Welsh nurse Hilda Davis — who was later to die tragically in a swimming accident at Spanish Point — the Stevensons had three sons: Walter Joly, or Joly — named after Stevenson’s friend and colleague — who was a consultant in occupational medicine in Ontario; Robert John — known as John — who became a tea planter in India [Walter himself was born in Calcutta]; and Richard David — known as David — who practised as a psychiatrist in Dublin. Only Joly is still alive today, and he travelled to Dublin from Canada for the event with his wife Maisie and Daughter Siobhán. Also in Baggot Street were Martine Stevenson, wife of the late David, and her daughter Natalia, son Sebastian, and some of their children — the great-grandchildren of Walter Clegg Stevenson.

Aged 91, Joly Stevenson has some trouble with his vocal chords, and asked his daughter Siobhán to read the following: “It is a great honour for the Stevenson family and for me to have a plaque unveiled in the house where my father lived and worked and where myself and my two younger brothers, John and David, lived until 1931, when my father died. I was 10 years old in 1931, but I do remember we played on the third-floor front room, which we called the nursery. I recall watching rail tracks being laid for the trams that ran along the street. I also remember walking to my kindergarten called Nightingale Hall, which was off the end of Waterloo Road. It took me half-an-hour to walk to school. There were very few cars on the road then; traffic consisted of horses and drays.

“Sixty Lower Baggot Street was a very interesting abode, especially for a child, with lots of rooms… There was a good-sized garden in the back of the house with a large stable at the end, for a horse, buggy and a hay loft. And father garaged his automobile there.

“My father’s office — the study, as we called it — was the first room on the right at the front hall. I recall on one occasion my father called me into his study to search for a radium needle that had fallen from its metal container. It was easy to find as it was glowing!”

Joly also recalled leaving 60 Lower Baggot Street in 1931 after his father died — just two years after the tragic death of his mother — describing it as quite a shock. “We moved to Leinster Road where my father’s aunts, who were elderly Victorian ladies, lived and who cared for us until we were old enough to care for ourselves.”

Medical community
Along with family, also present at the event were a number of eminent physicians, including Prof Peter Daly, Consultant Oncologist from TCD and St James’s Hospital; Prof Peter Gatenby, Ireland’s first full-time Professor of Clinical Medicine, TCD; and physician and eminent historian Prof Davis Coakley, who included a chapter on Stevenson in his book Irish Masters of Medicine, which contains biographies of 42 Irish medical personalities who have left their mark on the knowledge and practice of medicine.

Prof Daly explained to the small audience how, along with Prof Shaun McCann and Prof Ian Temperley, they established a haematology/oncology unit at St James’s Hospital in the late 1970s.

Joly Stevenson, son

After undertaking bone marrow transplantation from about 1985 onwards, the team decided to look around for a suitable person after whom to name the ward. “I am sad to say Denis Burkitt was to be more famous than Walter Clegg Stevenson, for his work in Africa. And of course he had a disease named after him. So we called our ward the Denis Burkitt Ward.”

But fate intervened, added Prof Daly, in 2000 in the form of Vancomycin-resistant Enterococcus, or VRE — a super bug infection. “At that stage we had to close down the ward and the transplants had to go to the UK while the unit was refurbished and converted to single rooms. When we reopened, haematology and oncology had to split, because of the reduction in the number of beds in the joint ward. So we started to say, whom could we name our oncology ward after? And it was then, of course, that we consulted the guru, Prof Coakley, and we found that we had in fact a very famous man who had been largely ignored — Walter Clegg Stevenson.”

Prof Daly recalled how they had actually found an original plaque that had been unveiled at Dr Steevens’ Hospital following Stevenson’s death. Surgeon to Dr Steevens’ Hospital and the Orthopaedic Hospital of Ireland in Upper Merrion Street, Stevenson was also consulting surgeon to the Ministry of Pensions and acted as Radium Consultant to the Rotunda. He was also a Knight of the Grace of the Hospital of St John of Jerusalem, and Examiner and Honorary Secretary of the Irish Centre of the St John’s Ambulance Association, and it is understood there is another plaque dedicated to him located somewhere in the St John’s Ambulance Association.

Stevenson Ward
The original plaque referred to above at Dr Steevens’ Hospital, however, was too heavy to hang on the walls of St James’s — thus a replica was made, explained Prof Daly.

The Walter Stevenson Ward is a 12-bedded unit, which specialises in oncology and haematology and is part of the HOPE Directorate at St James’s.

“Even though I am retired I have just come back from the American Society of Clinical Oncology meeting in Chicago, and of course it is all talk now of ‘bench to bedside’ and the physician scientist. It is true that many of the new targeted treatments for cancer are developed at the research bench and very quickly translated to the bedside. But of course it took two people in those days to do such pioneering work.”

Prof Daly added: “It is amazing to think that [Wilhelm] Röntgen discovered x-rays in 1895; the Curies were, in a few years, shovelling coal and extracting radium from their pitchblende, and then all of a sudden in Ireland in the very early part of the 20th Century you have Joly and Stevenson working happily away and bringing the latest technology, and indeed as it says in some of the obituary notices, in the BMJ, for instance, many people came to Ireland to learn the technique. So I think they were true pioneers and brought their discoveries very quickly to the bedside.”

Adding his own anecdote, Prof Davis Coakley stated that he had just come from the College of Physicians, where they had held an open day and an ongoing slideslow of Irish scientists who had made an original contribution to medicine. “Walter is one of those,” he said.

“They have the table from Sir Patrick Dun’s, the famous table on which the young doctors and students wrote their initials — and I was having a cup of coffee this morning and looking at it. ‘WC Stevenson’ is carved on the table in a very prominent position.”

In his tribute to Stevenson in the IJMS, Prof Joly said the death of his wife in 1929 was “a blow from which he never recovered”. Walter died of pneumonia at the age of 54.

Yet his medical legacy was to live on.