Lives of the fellows

Ernest George Knox

b. 6 July 1926 d.6 March 2017 MB BS Durh(1949) MD(1956) MRCP(1956) FFCM(1972) FRCP(1973) FFOM(1985)

Ernest George Knox, known as George, was a professor of social medicine at Birmingham University. He was born and brought up in Newcastle upon Tyne, the son of Eddie Knox, an electrician, and Annie Knox née King, a miller’s daughter. He won a scholarship to the prestigious Dame Allan’s School and during the war was evacuated to the Lake District. He typically made the best of this, enjoying outdoor pursuits and meanwhile forging some lifelong friendships. George met his future wife Betty (née Adamson) when they were both aged 13, after which they were inseparable. They married in 1950 and had three children.

George was the first person in his family to go to university, obtaining his MB BS from King’s College, University at Durham, in 1949 and his MD in 1956. In a climate of post war austerity, George recalled his 21st birthday celebration as cycling into Newcastle to buy a couple of bottles of brown ale. Betty remembers typing his thesis late at night after the children were asleep. They had no private transport and luxuries were scarce. Locum posts served as family holidays and accommodation was rented and basic. Research grants had to be found as a means of income.

Early professional inspiration came from working with Sir James Spence [Munk’s Roll, Vol.V, p.386] as a house officer and registrar in paediatrics at the Royal Victoria Infirmary in Newcastle upon Tyne from 1949 to 1951. There followed a series of research fellowships, including a Medical Research Council clinical research fellowship, and then posts as a lecturer and senior lecturer in paediatrics in Newcastle. Relocating to Birmingham Medical School as a senior lecturer, George was appointed as professor of social medicine in 1968. He helped establish and lead the developing health services research centre at Birmingham University, now an institute with 300 employees. George was a staunch believer in the ethos of the National Health Service and was instrumental in the development of the Faculty of Public Health as it evolved from the Faculty of Community Medicine.

His interest in the epidemiology of child and maternal health morbidity was fostered by his work with the Thousand Families Study. This landmark project arose from Spence`s observations of high infant mortality in Newcastle. George would lead the weekly Saturday morning research meetings. This study continues today, measuring multiple health outcomes for the original babies, now 70. George was co-author of Growing up in Newcastle upon Tyne. A continuing study of health and illness in young children within their families (London, Published for the Nuffield Foundation by the Oxford University Press, 1960) and The school years in Newcastle upon Tyne, 1952-62 (London, etc., Oxford University Press, 1974).

George was a prolific writer, publishing 176 original papers between 1953 and 1993, and writing many more after his retirement in 1992. He was author or co-author of 18 books, including standard text books on public health. His bibliography is too extensive to precis, but included the following studies: rhesus ABO incompatibility, maternal smoking, childhood accidents, fluoride in drinking water, cervical carcinoma, the epidemiology of congenital malformations, intussusception, deafness, still birth and early infant death. He researched the epidemiology of AIDS as the epidemic started, and evaluated the merits of screening programmes for other diseases. These topics were revisited in collaboration with other researchers as time progressed and new evidence surfaced.

His work with health services planning and public health necessitated extensive travelling and his work was translated into many languages. A particular interest was the study of childhood leukaemia and other childhood cancers, and led him to highlight the dangers of intrauterine exposure to pollution, including radiation and the atmospheric transmission of engine exhaust, particularly diesel. This stimulated considerable media interest. George would conclude his writing with recommendations for further action. He did not aspire to be a politician, but adhered to the principles of transparency and public debate, and the responsibility of governments to act on the basis of significant evidence.

Creative, original thought was the cornerstone of George's inspiring legacy of work, and sound statistical method and applied computer technology underpinned its execution. In this he was way ahead of his time. A self-taught mathematician, he soon realised that computers were the future. In their infancy in Newcastle, these early gargantuan machines were housed in specially controlled environments, emitting noise and forests of ticker tape and paper covered in binary numbers. He wrote early computer programmes and publications concerning the progress and challenges of medical computing. He designed mathematical modelling tools and invented an eponymous test called a Knox analysis, which looks for evidence of space time clustering based on last place of residence and date of death. Searching for clusters engaged George to the point that it was normal conversation at the dinner table.

George was an inspirational teacher. Undergraduate and postgraduate students alike described him as informative and entertaining. He was approachable and open to questioning. When a student enquired at the end of a lecture why the professor was wearing odd socks, he was amused. George had no interest in formal dress codes or indeed formality of any sort. He ran a very happy and productive department at Birmingham medical school for many years. He was highly regarded and described as a ‘lovely man to work with’. A former colleague said that although George was eminent ‘he never talked to you as if you were less clever than him’ and was completely unassuming. In addition to having a supreme intellect, he also had a quirky sense of humour and another colleague recalls that there was ‘never a dull moment with George’.

George was a devoted husband and he and Betty shared 66 years of marriage. Betty was a constant support, enabling him to pursue his career. Together they enjoyed their shared hobbies of painting and walking, and family holidays in Bamburgh, St David’s and Scotland. He was an affectionate and supportive father to his three children, David, Vivien and Andrew, and doted on his granddaughter, Gaby. He was immensely proud of all of their achievements. A practical man, he would prefer to make or mend things rather than pay others to do so. He could fix cars and bikes and various ailing machines. He famously built a wooden boat that capsized, to the chagrin of his youngest son, and made some robust furniture, which is still in use. He was a keen photographer and produced some beautiful albums.

George was without prejudice and a true egalitarian. He had a low tolerance of politicians and advertisers. Brilliant, authentic and driven by his relentless search for truth, he was tenacious in achieving his goals. He very rarely lost his temper, was not given to outward expressions of emotion, but was always available if you were in trouble. He was not a partygoer, but was nevertheless entertaining on social occasions. His enquiring mind and interest in all things meant that he could engage on any subject and it was unusual to find a topic about which he knew little. He loved a debate and would often expound theories, some more preposterous than others.

Retirement to Great Comberton in Worcestershire allowed George to continue his research at leisure, as well as indulge his interests in art, gardening and ancient monuments. He wrote a book, yet to be published, about standing stones and their possible use as navigational aids and chronological devices in ancient times. This involved three of his favourite things: exploring the countryside with Betty, studying ordinance survey maps and computer analysis. His mind was undimmed with age and he was completing The Times crossword right up until the point when he was admitted to hospital and succumbed to pneumonia.

Vivien Knox

[Christine MacArthur; Anne Watkins; BMJ 2017 358 3556 www.bmj.com/content/358/bmj.j3556?variant=full-text&hwoasp=authn%3A1512553465%3A1019339%3A1454434153%3A0%3A0%3Ai4Wrk6LzaCvUtp8Jj3%2FRtg%3D%3D – accessed 5 December 2017]

(Volume XII, page web)

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