Lives of the fellows

Keith Percy Ball

b.8 December 1915 d.10 January 2008
OBE(1985) MB BS Lond(1938) MD(1940) MRCP(1940) FRCP(1961) FFCM(1981)

Keith Ball was a consultant cardiologist at the Central Middlesex Hospital, London, and an early campaigner against smoking. He was born in north London, the son of Leonard Charles William Ball, a dentist, and Eileen Mary née Webb. He was educated at Bishop’s Stortford College, and then studied medicine at Middlesex Hospital, qualifying in 1938. He held house posts at the Middlesex and Brompton hospitals, and was then a registrar at Stoke Mandeville and the Middlesex. He then held a post as a senior registrar at the Central Middlesex Hospital.

Having been rejected for military service on grounds of ill health, he worked in London during the war years, at the Middlesex, and was particularly involved with staff health. This included dealing with tuberculosis among the nurses, an experience which perhaps set the stage for his later work on prevention. From 1945 to 1946 he volunteered for the United Nations Relief and Rehabilitation Administration, working with refugees and inmates of concentration camps. The association between deprivation and physical disease was all too stark.

He returned to UK and became a consultant at Central Middlesex Hospital, where a group of highly influential clinicians were working, including Richard Doll [Munk’s Roll, Vol.XII, web], Francis Avery Jones [Munk’s Roll, Vol.XII, web] and Horace Joules [Munk’s Roll, Vol.VII, p.307]. Central Middlesex Hospital at the time had a heavy community orientation. Horace Joules and Avery Jones were much concerned with the common diseases in the local community. Hugh Toussaint was running a very innovative community-based programme for the treatment of tuberculosis, and Jerry Morris’s research unit was based there. Morris and Doll championed the epidemiological approach. Richard Asher [Munk’s Roll, Vol.VI, p.16] later joined the department.

This was the beginning of the National Health Service, and there can have been few hospitals more exciting to work in at the time. Keith raised local industry funding to build one of the first district general hospital cardiothoracic departments containing a research unit, where early work was carried out on the links between diet and coronary heart disease, and between occupation and smoking and chronic bronchitis. He ran one of the earliest ‘anti-smoking clinics’ and was involved in early trials of nicotine substitutes, including chewing gum. His interest in the preventive approach to coronary heart disease and chronic bronchitis grew.

Keith was a keen undergraduate teacher. He was the first sub-dean at Central Middlesex Hospital and a primary moving force in persuading the medical school to build Horace Joules Hall – a residence for students with provision for what originally were intended to be laboratories, but which were subsequently converted into teaching areas. He trained many Middlesex Hospital medical students and continued to teach foreign students as his international career developed.

Even in areas where he was not intimately involved, he was a strong supporter of service development. Central Middlesex opened the third coronary care unit in the country and latterly one of the first district general hospital intensive care units, and Keith strongly backed both.

He became very aware of the harmful effects of smoking and, as more evidence accrued, decided, with colleagues, to take a stand against it. This was brave at a time when few doctors were campaigning on the issue and there were powerful industry forces opposed to any control. He co-founded Action on Smoking and Health (ASH) in 1971 and was the first honorary secretary. Later he was involved with the Coronary Prevention Group and the National Heart Forum.

When he turned 60, Keith retired from active clinical medicine and became an academic in public health and community medicine at London University. He took his ideas about preventive medicine abroad to developing communities in the Middle East, Africa and Asia, with the aim of embedding the principles of preventive medicine in countries which had yet to be industrialised, before they picked up bad habits. He had a particularly strong link with Ladakh, where he helped to found the Ladakh Institute of Prevention. He also drew attention to the effects of giant dust storms on the lungs (silicosis) and the relationship between tuberculosis and silicosis. As his physical health deteriorated he was unable to travel so widely and he had to be content to realise that many of the countries he had worked in had introduced preventive measures. In England he was delighted when the ban on smoking in public places was introduced.

How did he achieve all this? He was a curious mixture; he had a quiet approach, but the vision and determination more often associated with ‘noisy’ individuals. He was an energetic and kind man with a gift for bringing people with a common purpose together. He was not afraid to take an unpopular position if he felt that right was on his side, and would always respect his opponents. Although he was not one of the ‘big beasts’ of the outstanding district general hospital that was then Central Middlesex, in his quiet and dogged way he perhaps achieved more than many of them. He was also unusual in combining the old fashioned ‘physicianly’ approach centred on the individual patient, with an understanding that medicine was broader than that. It needed a less personal approach, both in the sense of more highly technical care and also in the sense of the need for population research and an understanding of the effects of physical surroundings and lifestyle on disease processes and prevention.

Keith Ball died aged 92, shortly after the Prime Minister announced a major initiative for the prevention of vascular disease. Keith would rightly have been enormously proud that his persistent belief that coronary artery disease was a preventable condition, and his relentless campaigning about environmental and dietary effects on health, had at last been recognised. It is only sad that he is not here to direct the resulting national programme. He is survived by his wife, Francesca, and three daughters. His son predeceased him.

Mark Dancy

[The Guardian 11 February 2008;The Independent 15 March 2008]

(Volume XII, page web)

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