Doctor for All Ills

When John Hilton Knowles was director of Boston's Massachusetts General Hospital, the elevator operator called him John, the nurses thought him charmingly handsome, and both the medical staff and trustees considered him something of a miracle worker. He burnished the hospital's already fine reputation. Under his leadership, the hospital's physical plant was partially rebuilt, while much of its ponderous bureaucracy was short-circuited. He promoted an extended-care unit for the aged and chronically ill, established clinics in Boston's heavily Italian North End and in depressed Charlestown. He engineered the opening at Logan Airport of a medical station linked with the main hospital for television diagnosis. He also had a humane eye for detail: he ordered the old wooden benches in M.G.H. waiting areas thrown out and replaced with groups of comfortable chairs. In ten years he increased annual donations sixteenfold, to $4,000,000.

While becoming one of the nation's best known medical organizers, Knowles also earned the enmity of organized medicine. The American Medical Association helped to blackball him as too radical when Robert H. Finch wanted to make him Assistant Secretary of Health, Education and Welfare in 1969. Only last month, the Massachusetts Medical Society formally censured him for accusing surgeons of performing too many operations for profit. Orthodox physicians are discomfited by his supercharged, fast-takeoff personality and his habit of shooting from the hip. Trained to shun publicity, they are scandalized by the fact that Knowles "talks in headlines" and gets a consistently good press. Last week the naturalized Brahmin moved to New York City to take over a new and more pow erful podium as president of the Rockefeller Foundation.

Being a new boy in town is nothing new to Knowles. The son of a World War I flying ace who became a successful drug company executive, Knowles attended schools, some private, in the cities where his father was stationed. After college (Harvard), he took his M.D. at Washington University in St. Louis, then interned at M.G.H. and was soon carving a promising career in research and the treatment of respiratory diseases. Ten years ago, when he was only 35, Knowles was named general director of M.G.H., the youngest in its 150-year history.

A firm believer in voluntary, private institutions, Knowles saw and still sees the big-city medical center, affiliated with a university, as the sun in a solar system of planetary hospitals and health centers. It is on this score that he admits his worst defeat, for 18 suburban community hospitals would have none of his regional planning notions.

Last year Knowles felt ready for the challenges of a new job. Offered the presidency of troubled Boston University, he pondered it for weeks, then turned it down. The Rockefeller Foundation promised what he wanted. Last week, as he settled into the foundation's Manhattan offices, Knowles had already spent six months globetrotting in six countries, inspecting Rockefeller-financed projects in education, agriculture development, nutrition and health. He had, he said, been learning fast. And characteristically, he already knew what he wanted the foundation to do.

One thing he does not want is yet another study of the American medical system. "We already know the facts," he says. "We have developed a fine af-ter-the-fact, high-cost, highly technical, curative system. We have done this to the exclusion of developing services with a high ratio of benefits to cost, such as rehabilitation, health education, preventive medicine, family planning services and the like. This has got to change." With the foundation's clout, disposing $50 million a year in income from its $800 million endowment, Knowles is the man to initiate change. He wants to use foundation-financed projects to determine how much the consumer gets for his health dollar, and of what quality, and how he can get more and better. Knowles believes that to survive, the private practice of medicine and private health insurance must give the patient a better break, or big government will take over everything.

For the longer term, Knowles' aims extend far beyond the purely medical field: "We must be concerned with the total health of the community--nutrition, education, welfare, justice, pollution, the availability of jobs, of decent housing." If he has his way, the Rockefeller Foundation will spend little on services that meet needs already recognized, but will stake out areas in public health and other fields where the problems have not yet been defined.

The Quick Clyster. Almost unanimously, those who have served under Knowles speak with adulation of his accessibility, of his willingness to give subordinates a free hand so long as they were doing well. In his Boston years, Knowles put in grueling days--in the office at 7 a.m. and seldom getting to his home near the Country Club in Brookline before 7 o'clock at night. The Knowleses (his wife comes of a wealthy stockbroking family) have six children aged ten to 18. Now Knowles begins his lectures on family planning by conceding that he is "not a prime example of responsibility in this area." But, he explains, his medical education included nothing on population or family planning, and his youngest child was born before Knowles recognized overpopulation as a problem.

To keep fit, Knowles plays squash and golf at his several clubs. (Membership in ethnically exclusive clubs would have been a handicap at Boston University, and Knowles says that he would have resigned from them if necessary.) He gave up cigarettes years ago, now smokes only an occasional ceremonial cigar. Knowles is a determined part-time author. He first wrote technical medical books, has recently finished a collection of essays on health care, and is planning his next opus on "what the '60s and '70s mean to this country." To an extensive library of American history and the social sciences, Knowles the bibliophile is adding works on the history of medicine. As a footnote to the history that Knowles is trying to make, Boston University two months ago gave him an honorary degree. Said the citation: "With the quick clyster of your ribaldry and moral outrage ... you fed physic to your own profession. You purged it. You goosed the quack."

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