Tribute to Dave Knox

In Memoriam Tribute to Dave Knox D avid Lalonde Knox passed away unexpectedly but peacefully in his north Baltimore home on February 1, 2022, at the age of 91 years. Dave was born in Chicago and moved to Houston with his mother at age 10 years. At this tender age, he had already decided to pursue a career in medicine. He attended Rice University followed by Baylor College of Medicine, where he was first exposed to ophthalmology through a clerkship with Louis Girard. He initially came to Johns Hopkins as a medical intern in 1955, often “hanging out at the Wilmer Clinic,” and then spent 2 years as an Army physician in Korea. It was here that Dave worked with an Army internist on disease caused by the liver fluke, an association that spurred a career-long interest in gastrointestinal topics. After completion of his tour of duty, he returned to Hopkins for his ophthalmology residency, followed by a fellowship at the Massachusetts Eye and Ear Infirmary with David Cogan. In these early years, Dave was exposed to many of the current and future “giants of Ophthalmology,” including Alan Woods, Frank Walsh, Ed Maumenee, and, later, Morton Goldberg. Dave and Woods developed an especially close relationship that lasted until Woods' passing. In 1967, Dave went to London and spent time at the National Hospital for Neurology and Neurosurgery, arranged by Ed Maumenee, then Chairman of the Wilmer Eye Institute, and Barrie Jones, Professor of Clinical Ophthalmology at the Moorfields Institute of Ophthalmology. Michael Sanders, the first “real” neuro-ophthalmologist in the United Kingdom, remembers that Dave “was the first person to teach us modern neuro-ophthalmology.” I met Dave when I was a first-year medical student at Hopkins in 1967. I was already thinking about a career in ophthalmology, and he was assigned to me as an advisor, in which capacity he arranged for me to spend a student FIG. 1. Dave Knox, Neil Miller, and Thomas Hedges at one of the early Frank B. Walsh meetings. In Memoriam: J Neuro-Ophthalmol 2022; 42: e531-e532 FIG. 2. Robert Hepler, Dave Knox, Bill Hoyt, and Neil Miller at an evening cocktail party during one of the NANOS meetings. elective with Bill Hoyt at UCSF, leading to my choosing neuro-ophthalmology as a career. When I became a junior faculty member on the Wilmer faculty after my fellowship, Dave and I shared a secretary and examination facilities for a year or so. During this time, I saw how meticulous he was at performing both a complete history and a complete examination. Three issues that he particularly stressed were the relationship of milk allergy, gastrointestinal disease, and poor dentition to eye disease. He also discouraged tobacco use of any kind and was particularly interested in its relationship to Buerger disease, about which he published an extensive overview shortly before his death. He constantly emphasized these associations to the residents and other attendees during weekly Grand Rounds at Wilmer. During his career, Dave published a number of articles that were seminal in the field of neuro-ophthalmology and ocular immunology, the topics of which included the role of folate in nutritional optic neuropathy, the ocular findings in ischemic orbitopathy, the association of inflammatory bowel disease and optic neuritis, the ocular findings in Whipple disease, and the occurrence of postviral benign sixth nerve pareses in children. In addition, he played a major role in the development of a yearly meeting, initially known as the Neuro-ophthalmology Pathology Conference (Fig. 1), that eventually morphed into what we now call the Frank B. Walsh portion of the annual meeting of the North American Neuro-Ophthalmology Society. This was a 1-1/ 2-day meeting at which unusual clinical cases were presented as unknowns, followed by the pathologic diagnosis according to a guest neuropathologist and/or ocular pathologist (which was not always what the presenter and his/her pathologist had diagnosed!). The first several meetings were held at the Wilmer Eye Institute, about which Bill Hoyt said that he loved coming to Baltimore for the meetings because there was nothing else to do but attend the conference! In recent years, Dave often said that he considered his e531 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. In Memoriam role in the founding of the Walsh Society Meeting, one of his signature accomplishments. One of the many great stories about Dave was his discovery of old pathology slides relating to a case that clinically had been diagnosed as Whipple disease 62 years earlier. Those of us who knew Dave knew that his office in general and his desk in particular looked as if it had been hit by a cyclone, the reason being that Dave NEVER threw anything away. The story was that a 47-year-old man with dementia, supranuclear ophthalmoplegia, and myoclonic ocular and facial jerks died in 1931, and the case was written up by Frank Ford and Frank Walsh as a case of “encephalitis” (Ford FR, Walsh FB. Bull Johns Hopkins Hosp 1936;58:80-88.) In 1993, David Zee and colleagues reviewed the case report and made a clinical diagnosis of Whipple disease based on the findings reported in the 1936 publication. To confirm their diagnosis, they then attempted to retrieve the pathological material, which turned out to be on Dave Knox's desk where it had languished for 33 years! The story as to why Dr. Knox had the material in the first place is recounted beautifully in the article entitled “Cerebral Ocular Whipple's Disease: A 62-year Odyssey from Death to Diagnosis” by David Knox et al in Neurology 1995;45:617-62. Dave continued to be active until well into his 80s, faithfully participating not only in Wilmer Grand Rounds but also in our monthly neuroophthalmology clinical conferences and in the yearly NANOS meetings (Fig. 2). Dave's son, Benjamin Knox, an orthopedic spine surgeon in Johnson City, TN, said of his father “Medicine was his mistress, but he was completely uncorrupted by careerism, research dollars, or Big Pharma influences. His honesty and dedication were an inspiration to me and many other aspiring physicians.” I completely agree with Ben. e532 In addition to his clinical work, Dave was active in teaching medical students, residents, and fellows. He performed numerous departmental duties including playing a key role in planning the dedication of the Woods Research Building and serving as the secretary of the Wilmer Residents Association. He also served for several years on the Johns Hopkins Medical Student Admissions Committee, including a 3-year term as Dean of Admissions. Dave delivered the Wilmer Memorial Lecture in May 2018, at that time he described his experiences during his 60 years of service to Wilmer, Johns Hopkins, and ophthalmology in general. Dave was not just a superb ophthalmologist but was an avid tennis player; he belonged to a local Baltimore tennis club for over 50 years. He also was a voracious reader of books, regardless of the subject. In addition, he had a great love of antique British cars and for many years drove a Bentley to and from the hospital that he often parked in front of the entrance to the Wilmer Institute. Over the years, I was fortunate to snag a ride in several of them! In addition to Dr. Benjamin Knox, Dave is survived by his twin daughters, Mary Elspeth Knox of New York, NY, and Lucinda Knox Herron of Brooklyn, NY, and his grandchildren, Micah Herron, Genevieve Herron, Abigail Knox, and Alexandra Knox. Neil R. Miller, MD Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland E-mail: [e-mail] ACKNOWLEDGMENT Thanks to Michael E. Piorunski, Wilmer Eye Institute Librarian, for providing several backstories about Dr. Knox. In Memoriam: J Neuro-Ophthalmol 2022; 42: e531-e532 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.