Prof. Robert KNOX Frcsed
- Born: 1791, St. Cuthbert's, Edinburgh, Midlothian, Scotland
- Christened: 26 Sep 1791, St. Cuthbert's, Edinburgh, Midlothian, Scotland
- Marriage: Mary RUSSELL in 1824
- Died: 20 Dec 1862, Hackney, London, Middlesex, England at age 71
- Buried: 29 Dec 1862, Woking, Surrey, England
Robert Knox's parents were natives of Kirkcudbrightshire from whence they moved to Edinburgh in the 1780s. His father, also called Robert, claimed a family connection with the great 16th Century Protestant Reformer and his mother Mary Scherer was of part-German ancestry. Robert Knox senior was originally a tenant-farmer of the Earl of Selkirk and he and his wife were dinner guests of the Countess of Selkirk on that famous night in 1778 when, in the absence of the Earl, her house was ransacked by Captain Paul Jones and a raiding party from his ship the U.S.S. Ranger. The Countess herself testified that the American marauders behaved with the utmost civility and indeed, many months later, Paul Jones returned to the Earl and Countess most of the silverware that he and his crew had looted from their house. It appears that, being a Kirkcudbrightshire man himself, he knew Mrs Knox and he sent to her a silver ladle which had presumably been stolen from the Earl. This ladle was eventually bequeathed by Mrs Knox to Robert, her second youngest son who often displayed it to guests in his Edinburgh home.
After moving to Edinburgh, Robert Knox senior became a schoolmaster and taught mathematics at George Heriot's School. He was a prominent Freemason and participated in the ceremonies which marked the laying of the Foundation Stone of Robert Adam's Edinburgh University Old College building in 1789. Robert Knox junior was the eighth of nine children and at an early age contracted smallpox which disfigured him considerably and destroyed the sight of his left eye. He was educated at the High School of Edinburgh (now the Royal High School) where he had a brilliant scholastic record. Among his contemporaries at the High School were such notable figures as Francis Horner, Henry Brougham and Henry Cockburn. He was head of every class and, in 1810, his final year, he was Gold Medallist and Dux of the school. In addition to these honours, he also received, from the Lord Provost and Town Council of Edinburgh, a Folio volume of the works of Virgil as a special prize for academic excellence and exemplary conduct.
Robert Knox junior entered the Medical Faculty of Edinburgh University in November 1810 and became an active member of many societies. As an undergraduate he achieved the remarkable distinction of being twice elected to the Presidency of the Royal Physical Society but, strangely in view of his subsequent career, he failed in Anatomy in his first examination for the MD degree. This was probably due as much to the gross deficiencies of the teaching provided by the University Department of Anatomy under Professor Alexander Monro tertius as to his multifarious extracurricular activities.
In order to make amends for this failure Knox joined the extra-mural Anatomy class of the famous Dr John Barclay, an anatomist of the highest international distinction who, at that time, was probably the greatest anatomical teacher in the British Isles. This was the beginning of an association which had momentous consequences for Knox and, as a result of Barclay's teaching combined with his own diligence and enthusiasm, he acquired an encyclopaedic knowledge of human and comparative anatomy. Thanks to this and to his rigorous classical education he was able to discourse eloquently on any anatomical subject in polished scholarly Latin. He graduated MD in 1814, his Thesis being entitled "De Viribus Stimulantium et Narcoticirum in Corpore Sano", which incorporated the results of careful clinical observations and showed much originality of thought. In the following year he produced his first scientific paper "On the relations subsisting between the time of day and various functions of the human body, and on the manner in which the pulsations of the heart and arteries are affected by muscular exertion". This was published in the Edinburgh Medical Journal and it records painstaking clinical observations from which he drew controversial but well-reasoned conclusions.
In 1815, Knox was commissioned Assistant Surgeon in the Army and his first posting was to Brussels where for three weeks immediately after the Battle of Waterloo he was heavily involved in the treatment of casualties from both the Allied and the French armies. He then returned to England in charge of 90 wounded soldiers from the battle and for this service received the official thanks of the Army Medical Department. About a year later, Knox was gazetted Regimental Surgeon to the 72nd Highlanders (later to become the Seaforth Highlanders) and sailed with his regiment to the Cape of Good Hope in 1817. He remained in South Africa for three years during which time he saw action in what became known as the fifth Kaffir War and, as befitted an Army Officer, he became an excellent horseman, a skilled swordsman and a first-class marksman. He travelled widely within the Cape Province and made an extensive study of its natural history and anthropology. He became particularly interested in the anatomical characteristics of the different African peoples and from this early beginning there developed the ethnological theories which he propounded with increasing enthusiasm for the rest of his life.
RETURN TO EDINBURGH
At the end of his overseas service in 1821, he received from Sir James McGrigor the formal thanks of the Army Medical Department for his survey of the Eastern frontier of the Cape Province and, later in that year, he returned to Edinburgh. He then obtained an extended period of leave from the army and he spent this attending the medical schools of Paris in which, at that time, there were some of the world's greatest medical scientists and teachers. Most of this time he spent with Cuvier, then the foremost anatomist in Europe. He also studied under luminaries of scarcely lesser fame such as Geoffroy Saint-Hilaire, de Blainville and Baron Larrey, with all of whom he established close friendships. By the end of 1822, Knox was back in Edinburgh and renewed his acquaintance with Dr John Barclay who offered him the post of assistant in his extramural Anatomy School (Figure 1). Knox accepted this offer and, at his own request, the Army Medical Department placed him on half-pay. It appears that the inefficient and labyrinthine military bureaucracy of that period lost all track of him for he remained on half pay until 1832 when he was retired with a gratuity of £100. Between 1821 and 1823, Knox produced several scientific papers, some of considerable merit, all of which were published in the Edinburgh Medical Journal and these covered a remarkable variety of subjects including the pathology of necrosis, the regeneration of bone, pericarditis and the treatment of tapeworm infestation.
Figure 1: Surgeons' Square 1826 showing Dr John Barclay's Anatomy School between (left) Old Surgeons' Hall and (right) the hall of The Royal Medical Society
Being now settled down again in Edinburgh, Knox married Mary Russell and in so doing, according to his biographer Lonsdale, "he inconsiderately put shackles to his social progress by marrying a person of inferior rank". For some time he kept his marriage secret, even from this close friends, but whatever effect it may have had on his "social progress" it certainly did not impede his professional advancement. He continued to produce a steady stream of original scientific papers mostly on anatomical subjects, but covering a wide range within this discipline. In December 1823, he was elected a Fellow of the Royal Society of Edinburgh. He presented many communications to the Royal Society and some of these embody important contributions to ophthalmic anatomy. There is no doubt that Knox was the first anatomist to appreciate the role of the ciliary muscle of the eye and, indeed, to recognise that this structure is a muscle and not a ligament, as had been traditionally supposed.
THE MUSEUM BEGINS
Over a period of more than 20 years Dr John Barclay had built up a large collection of anatomical specimens and preparations which were housed in his Anatomy School at No 10 Surgeons' Square. The collection reflected his major interest in the field of comparative anatomy. In 1821, he offered this collection as a gift to the Royal College of Surgeons of Edinburgh on two conditions - that a hall be built to house the collection suitably and that it should be associated with his name in perpetuity. This generous donation and the conditions under which it was made brought home to the surgeons the fact that the College building (Old Surgeons' Hall) in Surgeons' Square had become inadequate for their purposes and that the acquisition of a new Surgeons' Hall had become imperative.
In April 1824, Robert Knox submitted to the Royal College of Surgeons of Edinburgh a plan for a museum of comparative anatomy, based on the Barclay collection and offered to establish such a museum for the College. This offer was accepted and, on 13 January 1825, Knox was formally appointed to the newly created post of Conservator of the College Museum. Soon afterwards Knox, together with Mr Watson, a senior Fellow, were deputed by the College to go to London and examine the anatomical and pathological collection accumulated by Mr Charles Bell (later Sir Charles Bell), a distinguished Edinburgh graduate who had become senior surgeon to the Middlesex Hospital and surgeon to King George III. Bell offered to the College the first refusal of his collection which he wished to dispose of and, on Knox's enthusiastic recommendation, the College purchased Bell's museum for £3000. Knox supervised the transfer of the museum from London to Edinburgh and made arrangements for its safe storage, until such time as the College had acquired premises in which the Barclay and Bell collections could be adequately housed. By this time, Dr Barclay's health was failing and in March 1825 he made Knox his full partner with joint charge of his extramural anatomy school.
KNOX THE TEACHER
Three weeks later Knox became a Fellow of the College and his probationary essay for admission to the Fellowship was entitled "On the causes and treatment of lateral curvature of the human spine". Dr Barclay died in August 1826 leaving Knox in sole charge of the anatomy school where, for some months before his senior partner's death, he had been giving almost all the lectures.
His fame as a teacher spread rapidly and by the end of 1826 there were more than 300 students enrolled in his extramural anatomy class (Figure 2). It would be impossible to imagine a greater contrast to the dull pedantry of Professor Alexander Monro tertius than Knox's brilliant lectures (Figure 3), which were always vividly illustrated by expert dissections. Indeed, one of the major attractions of Knox's anatomy class was his guarantee that students attending his course would see the human body completely dissected. Not surprisingly, Knox's remarkable success as a teacher aroused the jealousy of various surgeons and anatomists who were also conducting extramural classes. There seems little doubt that he exacerbated this situation by his intellectual arrogance and his inexcusable propensity for ill-concealed denigration of professional colleagues. Among those whose hostility Knox incurred was James Syme, later to become Regius Professor of Clinical Surgery in Edinburgh University, who vehemently opposed his appointment as Conservator of the College Museum.
Knox's major achievement as Conservator was the preparation of a complete museum catalogue which included all the items of the Barclay and Bell collections. He also arranged for the storage in his anatomy school of specimens from these collections which could not be accommodated in Old Surgeons' Hall. The College had, in the meantime, acquired a site in Nicolson Street for a new Surgeons' Hall. The distinguished architect William Henry Playfair was commissioned to design a building, appropriate to the dignity of the College and which would provide proper accommodation for its museum.
Playfair's plans were completed in early 1828 and, in preparing them, he was advised by Dr Knox regarding the requirements of the College museum.
Knox's teaching activities continued to increase steadily and in the academic year 1827-1828 no fewer than 504 students were enrolled in his course. Because of this large number the class was divided into three groups and Knox had to give each of his lectures three times over. He employed a number of assistants and demonstrators some of whom subsequently gained fame in their own right as surgeons and anatomists. The most notable of these latter was William Fergusson, ultimately to become President of the Royal College of Surgeons of England, Surgeon to Queen Victoria and a Baronet. It was, however, at this time that Knox became unwittingly involved in the scandal that was to bring about his ruin.
BURKE AND HARE
On 29 November 1827, an old army pensioner, without friends or relatives, died in a lodging house in the West Port belonging to William Hare. He had died of natural causes owing rent to his landlord and Hare decided to obtain reimbursement and to avoid funeral expenses by selling the corpse to Professor Alexander Monro tertius in the University Anatomy Department. In order to convey the cadaver to the University Hare enlisted the aid of his friend William Burke and, quite by chance at this stage, they fell in with a medical student (a member of Knox's extramural anatomy class) who told them that they would obtain a much better price for their burden at Dr Knox's school than they would from Professor Monro. They took this advice and proceeded to No 10 Surgeons' Square where they were paid £7.10/- for the cadaver. This gratifyingly easy money encouraged Burke and Hare to start murdering old vagrants and other homeless people whose deaths would be likely to pass unnoticed and whose bodies could be sold to Dr Knox's anatomy school.
During the following year they murdered at least 16 such individuals and they may well have done away with more than that. Their crimes were eventually discovered at the beginning of November 1828 and immediately provoked a furious popular outcry. Dr Knox was publicly vilified and only narrowly escaped mob violence but there is no evidence that he ever had any personal dealings with Burke and Hare. In fact, far from being accused of any crime, he was not even summoned to give evidence at the trial of William Burke. Hare saved his own neck by turning King's evidence and, indeed, without Hare's testimony it is doubtful if the Crown could have obtained a conviction. Burke was found guilty and sentenced to death by hanging and the court also ordered that his body be publicly dissected by Professor Alexander Monro tertius. Burke was duly hanged in the High Street outside St Giles Kirk on 28 January 1829 and the subsequent public dissection of his body attracted a large crowd. While the dissection was in progress some sort of disturbance occurred and in the confusion most of the skin which Professor Monro had removed from the corpse was stolen. Some weeks later, wallets and pocket books made from the tanned skin of William Burke, were being offered for sale on the streets of Edinburgh. One of these was acquired by the College in the early 1900s, and is on view in the museum.
During the furore that followed the arrest of Burke and Hare and the trial and execution of Burke, Knox maintained complete silence but the Edinburgh populace, at large, regarded him as being only marginally less culpable than the murderers and during this period he was obliged to travel about the city with the greatest circumspection. The general public's feelings were well expressed in a rhyme which circulated widely at the time.
Doon the close and up the stair
Butt and ben wi Burke and Hare
Burke's the butcher, Hare's the thief
And Knox the boy that buys the beef!
Knox took the precaution of carrying with him a loaded pistol and a Highland dirk wherever he went. He was certainly capable of defending himself against physical assault, but the Edinburgh mob did attack his house and, although they failed to force an entry, they broke most of the windows in the house. The general feeling of outrage persisted for some time after Burke's execution and, in March 1829, Knox was held up to public execration in a vicious article by Professor John Wilson (alias Christopher North), published in Blackwood's magazine. This made it essential for Knox to defend his reputation and he invited nine distinguished persons to form a committee for the investigation of the rumours and allegations about him. This committee, of which the Secretary of the Royal Society of Edinburgh was the Chairman, included prominent members of the medical and legal professions and its findings exonerated Knox from all complicity in the murders carried out by Burke and Hare. In spite of the committee's report, Knox found, at this crisis in his career, that he had very few friends and, of course, the numerous enemies that he had made were not slow to seize the opportunity of venting their spite upon him. His huge class of students did, however, remain totally loyal to him and his teaching continued without interruption.
Although Knox was the Conservator of the College museum there is no reference to the Burke and Hare scandal in any College archive. Indeed, almost at the very time when the murders came to light, the Council minutes include a warm commendation of Knox's conservational activities. It is almost certain, however, that the senior Fellows of the College were affronted by their Conservator's involvement in this gruesome affair and there is no doubt that he was ostracised by most of his professional colleagues. In spite of this, there is no evidence that the Council ever contemplated his dismissal and he continued his work for the College with undiminished energy.
In September 1829, his enemy James Syme was appointed one of the curators of the College museum and from then onwards relationships between Knox and the Council became increasingly strained. Eventually, Knox submitted his resignation as Conservator on 1 July 1831 and this was accepted without comment. The new Surgeons' Hall was still under construction and it must have been a bitter blow to Knox, after his devoted conservation of the Barclay and Bell collections, to be denied the opportunity of supervising their installation in a purpose-built museum to the design of which he had made important contributions. In spite of these difficulties and antagonisms, Knox continued to do occasional work for the College museum, mostly without remuneration until his departure to London in 1842.
Knox carried on with his anatomical teaching and, at first, his popularity as a teacher seemed totally unaffected by the Burke and Hare scandal. He attended regularly the meetings of the Royal Society and made frequent contributions to its proceedings. He continued to produce a stream of scientific papers on a wide variety of subjects, many of which were published in the Edinburgh Medical Journal and some of which appeared in the Lancet and in the London Medical Gazette. However, by 1836, the number of students attending his extramural anatomy course had declined significantly and it is not entirely clear why this should have happened. Delayed repercussions of the Burke and Hare scandal would seem to be an unlikely cause. An important factor may have been the retirement of Professor Alexander Monro tertius from the University Chair of Anatomy with the consequent marked improvement in the standard of University teaching of anatomy. The decade 1830-1840 saw a reduction in the number of medical students attending Edinburgh University and this was probably another significant factor. Whatever the reasons for the decrease in size of his anatomy classes, it is clear that Knox's circumstances became somewhat straitened and he applied unsuccessfully for a number of posts including the University Chair of Pathology and the Professorship of Anatomy at the Royal Scottish Academy. He tried to establish an extramural school of Anatomy in Glasgow, where the number of medical students was increasing, but this was not successful. Whatever chances he may have had of obtaining academic preferment were forever destroyed by the intemperate diatribe against the Edinburgh medical establishment which accompanied his application for appointment to the University Chair of Physiology in 1841. In that year, to the bitterness of professional disappointment, the deaths of his wife and one of his children added a heavy burden of personal sorrow.
KNOX IN LONDON
In 1842, he left Edinburgh for London and it must be emphasised that although his circumstances were reduced he certainly did not spend the rest of his life in poverty and obscurity. In fact, he was much in demand as a lecturer and continued to be a regular contributor to scientific journals. Knox's publications during this latter period cover an astonishing variety of subjects. As the years passed, however, an increasing number of articles were devoted to the ethnological theories which originated from his anatomical studies of the indigenous races of South Africa, and with which he became more and more obsessed. Quite apart from their lack of scientific validity, these theories might be held to be almost as obnoxious as the racial doctrines of Nazi Germany or the socio-political concept of Apartheid. On the other hand it is likely that those who would most vehemently object to Knox's view of the ethnic inferiority of the African peoples, would applaud his strongly expressed condemnation of the effects of European colonialism upon Africa.
For some years Dr Knox engaged in part-time general medical practice in Hackney, then an area of gross social deprivation, and it is on record that he made no charge for his professional services to a large proportion of his patients. Upon the outbreak of the Crimean War in 1854 he volunteered for service as an Army surgeon but was rejected by the War Office on the grounds of his age. This seems strange in the light of the fact that the Commander-in-Chief of the British Army in the Crimea and most of its divisional commanders were veterans of the Napoleonic campaigns.
In 1856, he was appointed Pathologist to the Cancer Hospital at Brompton, later to become the Royal Marsden Hospital and this, combined with his general practice, his lecturing and his writing, kept him fully occupied, but never again was he able to gather to himself a huge class of enthusiastic students such as he had taught in Edinburgh in his heyday.
The approach of his 70th birthday was attended by a decline in his physical strength and energy but his mental acuity remained unimpaired. On the 9th of December 1862 he returned home exhausted after a long day at the Cancer Hospital and that night he sustained a major stroke during his sleep. He never regained consciousness and died the following day.
He had often spoken of the beauty of the flowers in Brookwood Cemetary near Woking and had expressed his wish "to be interred there in some spot where the sun might shine longest on the green sod above my grave". He was buried there on the 29th of December and the funeral was strictly private but some time later a group of his former students and assistants, including Sir William Fergusson, declared their intention to erect a memorial over the grave of their revered teacher. Nothing came of this and the site of Knox's last resting place was forgotten until it was rediscovered in 1966 by Professor Eric Mekie, Knox's lineal successor as Conservator of the College museum. Professor Mekie and Sir John Bruce, then Regius Professor of Clinical Surgery in Edinburgh University, arranged for clearance of the weeds and foliage which had overgrown Knox's grave and for this to be marked by a granite stone, inscribed simply "Robert Knox - Anatomist 1791-1862" (Figure 4).
Figure 4: The granite memorial placed over Knox's grave in Brookwood Cemetery by Sir John Bruce and Professor Eric Mekie
There is no doubt that Robert Knox was a man of high intellectual attainments and it could be claimed that he was one of the greatest medical teachers of all time. Certainly, no other teacher in the history of the Edinburgh medical school excited such loyalty and enthusiasm in so many students or attracted to his lectures so many representatives of sister professions and other non-medical members of the Edinburgh intellectual and social Establishments. As a teacher, Knox was a considerable showman and each of his lectures was a well rehearsed performance. Although not well favoured by nature and with features rendered even less pleasing by the ravages of small-pox, he had an extraordinary charm and a personality which made him universally attractive, especially to women. He compensated for his unprepossessing appearance by dressing in the height of fashion. According to Lonsdale, "Dr Knox was wonderfully got up in the way of costume and was perhaps the only lecturer who ever appeared before an anatomical class in full dress. Being a well made person his tailoring was all the more effective for his display of the glass of fashion and the mould of form. A dark puce or black coat, a showy vest often richly embroidered with purple across which gold chains hung in festoons, a high cravat, white or in coloured stripes, the folds of which were passed through a diamond ring, a prominent shirt collar, delicately plaited cambrics, watch seals and pendants set off by dark trousers and shining boots completed his outer man. Knox in the highest style of fashion with spotless linen, frill and lace and jewellery redolent of a duchess's boudoir standing in a classroom amid osseous forms, cadavera and decaying mortalities was a sight to behold and one assuredly never to be forgotten."
Throughout his time as a teacher of anatomy in Edinburgh, Knox seems to have been almost constantly involved in scientific controversy of one sort or another, and some of the disputes in which he engaged became extremely acrimonious. His temperament was naturally combative and this combined with his encyclopaedic knowledge and keen intellect made him a formidable adversary but his frequent contemptuous disparagement of the opinions and abilities of colleagues and especially of other teachers indicates a serious defect in his character which did him infinite harm Although publicly arrogant and querulous Knox in his own home was the most genial and hospitable of hosts renowned for his brilliant conversation and for his wit and repartee. He was passionately fond of music especially the works of Schubert and Rossini and was an amateur violinist of considerably more than average skill. His violin which was acquired for the College by Professor Eric Mekie in 1979 is on display in the museum. It is a fine instrument and has been played in recent times on a number of special College occasions.
Knox's publications show that he was a careful accurate observer with an enquiring restless mind and considerable analytical powers. But for the calamity which befell him in 1828 he would have been the obvious candidate to succeed the dull, lazy and incompetent Monro tertius in the Edinburgh University Chair of Anatomy and there is no knowing what scientific heights he might have scaled in that position. His services to the Royal College of Surgeons of Edinburgh were of inestimable value and he is the true founder of its celebrated museum. Nevertheless, any review of Knox's place in Edinburgh medical history must inevitably end with the unanswerable question - Did he know or even suspect the true provenance of the "subjects" for which his extramural anatomy school paid money to Burke and Hare? He never met either of the two murderers but certain of his assistants, including perhaps William Fergusson, certainly did and we have to ask ourselves whether they and their master should have been prosecuted as accessories to the crimes of Burke and Hare.
Knox is, of course, the hero of James Bridie's play "The Anatomist" and the leading part was originally conceived by Bridie as a vehicle for the talents of that great Scottish actor Alastair Sim. Tom Fleming's interpretation of the part has been equally memorable and the play presents a fascinating if controversial view of Knox's character and personality. It is possible to discern in his life and career those two essential elements of Greek tragedy, Hubris and Nemesis, but in spite of the obloquy still associated with his name there is no doubt that he made contributions to medical science and teaching of which both the Edinburgh Medical School and the Royal College of Surgeons of Edinburgh can be justifiably proud. He can have no better epitaph than his own words,
"I would rather be the discoverer of one fact in science than have a fortune bestowed upon me"
Copyright date: 1 November 2000
Correspondence: I. MacLaren, 3 Minto Street, Edinburgh EH9 1RG, U.K.
©2000 The Royal College of Surgeons of Edinburgh, J.R.Coll.Surg.Edinb. 45, 6: 392-397
Robert married Mary RUSSELL, daughter of William RUSSELL and Elizabeth GREIG, in 1824. (Mary RUSSELL was christened on 1 Nov 1788 in St. Cuthbert's, Edinburgh, Midlothian, Scotland and died in 1841.)