The Legacy of Doctor Knox

The surname Knox is, in a Scottish context, invariably linked to the Calvinist reformer John who, by some, is credited with the favourable enhancement of souls. However, some two centuries after the reformer’s death, another Knox, Robert, was certainly of more physical benefit to the population of Scotland – and indeed internationally.

Robert Knox was born in Edinburgh on 4 September 1791 and named after his father who was then Master of Mathematics at Heriot’s School. A bout of smallpox in early life caused  young Robert to lose his left eye, but the loss, which created a somewhat forbidding appearance in later life,  did not prove detrimental during his subsequent education at Edinburgh High School where he excelled in most subjects. Knox  was school Dux and Gold Medallist in 1810, before matriculating to study medicine at Edinburgh University.

Knox’s initial medical progress was slow and, despite his eventual eminence in the subject, he failed his first anatomy examination – before becoming a pupil and protege of  Doctor John Barclay. He eventually graduated M.D. in 1814.

Commissioned assistant army surgeon in 1815, he was posted to Belgium and in the post Waterloo carnage, gained practical diverse surgical experience. Knox was dismayed at the army medical and hygienic conditions then prevailing, but the aftermath of that high profile Belgian battle provided him with surgical knowledge which might have otherwise taken years to assimilate.

From 1817 to 1820, he served in South Africa where he continued to complain about the  prevailing abysmal military medical and hygienic conditions. On Christmas Day 1820 he returned to Edinburgh and effectively ended his military field service, although he remained a reservist on half pay until finally being discharged in 1832 with a gratuity of £100.

Military permission was still necessary, and granted, to allow Knox to continue his studies in Paris between 1821 and 1822.

In 1824 he quietly married a woman  considered, by some, to be of a lower social class. There were however, six children of that union before the premature death of Mrs Knox  in 1841. It had been  suggested that the nature of his marriage might have a detrimental effect on Knox’s career prospects but there is no evidence of such an impediment. By 1825, he was  a Fellow of the Edinburgh Royal College of Surgeons, a body which he persuaded to create a museum of pathology and anatomy, with him as conservator – a post which he held until 1831. That museum has developed into a popular public visitor attraction at the Royal College of Surgeons.

Also in 1825, his old Edinburgh lecturer John Barclay decided to retire but, before doing so, enlisted  Knox as a partner in his anatomical school. When Barclay died unexpectedly in early 1826, Knox inherited both the school and the position of chief anatomical lecturer. In that situation he also achieved success and, by 1829,  had in excess of  500 pupils.

He achieved great fame as a lecturer. Knox sometimes ridiculed his peers but his obvious knowledge and teaching ability provided motivation to hundreds of students who would themselves later achieve fame. For a large part of the 19th Century the Edinburgh anatomical schools provided surgeons for London, other English hospitals, and extensively abroad.

Anatomical study  of course required cadavers for dissection. Prior to the Anatomy Act of 1832 – which permitted a controlled supply of unclaimed bodies from hospitals and workhouses – a supply of bodies for dissection  was hitherto legally confined to the remains of executed criminals. Considering the number of anatomy students then in Edinburgh, that source was obviously inadequate.

Burke and Hare
This situation led to the creation of so called resurrectionists, or grave robbers, with, in Knox’s case, his unfortunate association with the infamous William Burke and William Hare.

Although often referred to as grave robbers, there is no evidence that Burke and Hare ever engaged in that sordid activity, but instead they perfected a method of suffocation by which they murdered their victims. Dr. Knox was known to pay £10 for fresh bodies in winter and £8 during the summer.

Burke and Hare were eventually apprehended  in 1828. Evidence of murder by the Irishmen was not considered absolute and the Lord Advocate, Sir William Rae, persuaded William Hare to give evidence for the Crown against his partner Burke, in return for his own freedom.

William Burke and his mistress, Helen McDougall, were tried at a hearing which began on Christmas Eve and, in keeping with the prevailing common legal practice, continued overnight until the jury found Burke guilty.  25,000 people attended his execution on 28 January 1829.  Throughout his trial, William Burke had remained adamant  that Knox knew nothing of the murders associated with provision of cadavers.

The entire legal procedure did however leave some stigma attached to Knox’s otherwise unblemished career. He acquitted himself well as a witness at Burke’s trial and, at a subsequent enquiry chaired by the Marquess of Queensbury , he was also exonerated. The panel “had seen no evidence that Dr. Knox or his assistants knew murder was committed in procuring any of the subjects brought to his rooms”.

Despite that apparent absolution, and perhaps on the basis that a doctor of his experience should have been able to determine the cause of death, Knox was personally accused by a contemporary, Professor Robert Christison, who lectured in medical jurisprudence and who considered the Queensbury enquiry to have been a white wash. Knox was burned in effigy by the Edinburgh Mob outside his Arniston Place house. He was not, however, intimidated and still moved freely around Edinburgh – but carried a brace of pistols when he did so. He also made some enemies among his contemporaries – in particular Dr. Monro, who publicly dissected the brain of William Burke after his execution.

Knox,  however, continued to enjoy the wholehearted support of his students and, on 11 April 1829,  they presented him with a gold vase as a sympathetic expression “of his suffering.”

Despite the Burke and Hare aberration, Knox’s school continued to thrive and, in 1832, together with his long time assistant William (later Sir William) Fergusson he moved to new premises in Surgeons Square to accommodate the increasing number of students who attended his daytime and evening lectures. Knox and Fergusson were joined there in early 1833 by the eminent Dr. John Reid.

Declining Popularity
For reasons which are not entirely clear,  Knox’s popularity steadily began to decline and by 1836, both Fergusson and Reid had moved on. He still taught pupils who would achieve greatness – such as Thomas Alexander (1812 – 1860) who rose to be Director General of Army Medical Services in 1858 – but overall the popularity of Knox’s school began to decrease.

He continued to write many medical papers and, in 1837, he anonymously produced an unsuccessful magazine the Edinburgh Dissector.  The same year he attempted to gain a vacant pathology professorship but was again unsuccessful.

In April 1839 he was joined by Doctor Henry Lonsdale who became his partner and demonstrator – and later his biographer. They moved  to new premises in Argyle Square but, despite his unquestioned ability, Knox’s popularity among his contemporaries continued to decline. He tried for a number of professorships but was consistently passed over. His penchant for sarcasm and reference to University Chairs  – for which he had unsuccessfully applied – as having “fallen much below the income of a steady going retail grocery or bakery” – did nothing to enhance his popularity.

When his wife died  in 1841, Knox became really unsettled. He embarked on a nationwide lecture tour from which he regained some of his declining popularity. He continued to tour and write – with success – but his applications for public posts were  consistently  blocked. Following a failed attempt to emigrate and lecture in the United States of America, he moved  to a smaller medical school in Portland Street, Glasgow, but that move also proved a failure and he returned the fees of his students.

The death of  Robert, his eldest son in 1854 caused Knox more distress and, soon afterwards, he  applied  to serve again as an army surgeon  – this time in the Crimea where many of his former students were serving. That application too was unsuccessful and no reason was given. He subsequently complained through numerous newspaper articles pointing out the denial could not be ability related or even because of his relatively advanced age, as the Crimean army Commander in Chief  – Lord Raglan  – was ten years his senior.

Leaving Scotland
Now thoroughly depressed, Knox  abandoned Scotland in 1856 and was appointed  anatomical pathologist at Brompton Cancer Hospital. Concurrently, he set up a private  medical practice in the Hackney district of London. He continued to write and embarked again  on lecture tours – confined to English venues – where he again began to enjoy success. It was success further reflected when, in 1860, the Ethnological Society of London made him first an Honorary Fellow then Honorary Curator of the society’s museum in 1862. He also gained more international acclaim through being elected a Foreign Member by the Anthropological Society of Paris.

Knox was contemplating his autobiography when, on 20 December 1862, he died at 9 Lambe Terrace in London. He was then 71 – the majority of those years spent striving to improve surgical knowledge and techniques. Many students who would later achieve fame – such as Simpson, Fergusson, Alexander, and the unfortunate McKenzie who died in the Crimea, all gained their initial experience at his Edinburgh School.

According to his nemesis Robert Christison, Knox died in a state of destitution and was buried on 29 December 1862 at Woking, Surrey, in an unmarked grave. Over a century later in 1966, Edinburgh’s Royal College of Surgeons – perhaps in realisation that  Knox’s life and ability had been unfairly tainted – laid a granite marker on that lonely Surrey grave.

Photographs reproduced by kind permisssion of the Royal College of Surgeons, Edinburgh.

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