Lives of the fellows

John Knowelden

b.19 April 1919 d.23 July 1997
CBE(1983) MRCS LRCP(1942) DPH(1947) MB BS Lond(1947) MD(1948) MRCP(1967) FRCP(1972) FFCM(1973)

John Knowelden was born in Lewisham, London. His father, Clarence Arthur Knowelden, was less well organized than his son would prove to be. Having sinecure employment with the Cable and Wireless Company he devoted much of his time and energy to his two passions, music and joinery. He was a conductor of orchestral and choral music, and turned out some notable pieces of reproduction furniture. His father before him had been a ship’s engineer, a capable designer and wood craftsman. John Knowelden’s own talent with wood came out in his retirement when he built a harpsichord for himself and played it well. His mother, Violet Chapman, came from a Devon family with sailing traditions. He gained his love of the sea and ships from her.

Academically John was always to the fore, but he avoided the limelight. He won entrance scholarships to Colfe’s Grammar School, Lewisham and St George’s Hospital Medical School. In 1947 he won a Rockefeller fellowship in preventive medicine to study at Johns Hopkins School of Public Health, Baltimore, and in the same year gained the DPH at the London School of Hygiene and Tropical Medicine with distinction.

Qualifying in 1942, he was commissioned as RNVR surgeon lieutenant and was almost continuously at sea for more than three years in a destroyer. He saw action in the North Atlantic, Mediterranean and Pacific. What he experienced moved him greatly. His values, including his tolerant spirit and his sense of proportion, were cast in those days.

Back from America, in 1949 he joined the London School of Hygiene and Tropical Medicine’s department of epidemiology and medical statistics as a lecturer, and as a member of the MRC statistical research unit. The unit was directed by Sir Austin Bradford Hill [Munk’s Roll, Vol.IX, p.235]. They were to establish a fruitful scientific partnership and an enduring friendship. As a member or secretary of various MRC committees John planned, supervised, analysed and reported on several of the most important interventions in communicable disease control in the 1950s. This was his most productive period. With Bradford Hill he established a clear connection between prophylactic inoculation and the subsequent development of poliomyelitis. This was confirmed in a subsequent study of inoculation procedures and the development of neurological lesions. They also found that the onset of poliomyelitis was associated with tonsillectomy, performed recently or years before. He was closely involved with the studies of the efficacy of whooping cough vaccine and took a major part in the planning and execution of the 1956 field trial of British poliomyelitis vaccine, involving two million children, which confirmed its effectiveness. There were clinical trials of antibiotics in pneumonia and bronchiectasis, and he had a major input, as co-ordinator, to the joint US-UK study of the efficacy of ACTH, cortisone and aspirin in the treatment of rheumatic fever.

He was becoming established as a major international figure in epidemiology. Under the auspices of the British Empire Cancer Campaign he spent two months in 1955 in Uganda advising the Kampala Cancer Registry on methods for the measurement of cancer incidence, and in 1958 undertook a similar assignment in Jamaica and Antigua.

But in 1960 it all changed. In 1958 the holder of the chair of preventive medicine and public health at the University of Sheffield, William Hobson, had unexpectedly resigned to join WHO in Geneva. Public health doctors had, up till then, been largely concerned with communicable disease control and the organization of community health services. University departments of public health had concentrated on training to support these functions. John Knowelden’s appointment to the chair in Sheffield was one of the first of those to base public health teaching and training on applied epidemiology. There he found kindred spirits in Erwin Stengel [Munk’s Roll, Vol.VI, p.415] and Philip Seager, professors of psychiatry, and Charles (later Sir Charles) Stuart-Harris [q.v.], professor of medicine and dean. He engaged fully in the academic and social life of the University.

While he was in great demand for collaborative research with clinical colleagues his own research effort appeared to lose impetus. The drive of Bradford Hill and his other colleagues at the London School of Hygiene was no longer along the corridor. Instead he became more of a facilitator of others. His book of that period with Ian Taylor, Principles of epidemiology, London, J & A Churchill, 1957, was a standard text. At the national level he had two spells as joint editor of the leading British epidemiology journal, the British Journal of Preventive and Social Medicine, between 1959 and 1969 and from 1973 to 1976; and in 1977 he became the academic registrar of the Faculty of Community Medicine (later Public Health Medicine), a position he held for six years. Also in 1977, most appositely to his marine interests, he was appointed civil consultant in community medicine to the Royal Navy. In 1983 he gained the CBE for his services to community medicine.

In 1966 however, there was a new stimulus. The Ministry of Health, principally in the persons of Dick Cohen and Michael Heasman, was concerned about the unexplained variations in the consumption of hospital in-patient care for apparently similar conditions. Archibald Cochrane [Munk’s Roll, Vol.VIII, p.95] had for some time been arguing for a scientific approach to establishing the effectiveness of different interventions and their costs. Randomized, controlled clinical trials were needed. John Knowelden was the man to conduct them.

The Ministry and the friendly regional hospital authority core-funded a medical care research unit in Sheffield under John’s direction. He assembled and blended an effective multi-professional group of researchers. The first study, which tested the cost-effectiveness of different lengths of hospital stay after inguinal hernia repair and was published in the Lancet, helped to authenticate short-stay surgery. This and later studies of alternative methods of health care delivery was stamped with the same meticulousness which characterized his MRC studies of prophylaxis. More than thirty years later his unit remains in the forefront of health services research.

He retired from his chair in 1984. Then for one year he filled a gap as deputy dean at the Sheffield Medical School. Typically unassuming, in the short interval before his emeritus professorial status was conferred he titled himself Dr Knowelden. He continued until 1989 to serve as a senior member of the juvenile panel at Sheffield Magistrates Court, where he started in 1962.

In 1946 he married Mary Sweet. His was as discerning in that choice as he was in his scientific studies. He was a homebird. They shared an appreciation of good order and a passion for music and gardening. They had two sons, one of whom became a GP principal in Scarborough, the other a senior clerk at the Sheffield Magistrates Court; thus continued the pattern of similar interests or pursuits which had passed down to John from previous generations.

During retirement he and Mary removed to a scenic position in a cliff-top villa at Scarborough - down to the sea again. Six years later he died there after eighteen months of pain which he endured with courage and good cheer.

John Knowelden was a modest, kindly man with great personal integrity. His word was his bond. He was never known to have made a vituperative comment. His reticence and taste for understatement meant that the generation which followed him would not easily notice his considerable contribution to the improvement of the public health.

Brian Williams

[The Times, 21 Aug 1997; Brit.med.J., 1997, 315, 887]

(Volume X, page 283)

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