Howard Andrew Knox (March 7, 1885 – July 27, 1949) was an American medical doctor and eugenicist specializing in heart and rheumatic diseases. Serving as an assistant surgeon at Ellis Island during the early 1900s, he made major contributions to intelligence testing through the methods he devised to screen immigrants for mental deficiencies.Knox, H. A. (1914). A scale, based on the work at Ellis Island, for estimating mental defect. Journal of the American Medical Association, 62(10), 741-747 However, at the time of his death, he was most well known as a veteran, a general physician, and a contributing member of his community, and his contributions to intelligence testing had become largely forgotten. Although his work in this area has become largely overlooked, his contributions have served as an important link between early intelligence research and present day intelligence testing.Richardson, J. T. (2013). Howard Andrew Knox: pioneer of intelligence testing at Ellis Island. Columbia University Press
Personal life
Howard Andrew Knox was born on March 7, 1885, in Romeo, Michigan. He was the only child of Howard Reuben Knox and Jennie Mahaffy Knox. Howard's father was originally from Ashtabula County, Ohio, and worked as a traveling salesman. Jennie was born in Romeo, although she spent her youth in Ireland until moving back to Ohio as an adolescent to help her father on his farm. Howard's parents were married in 1879, after which Howard Senior moved in with Jennie to help on her father's farm in Romeo. When Howard A. was born, the three generations moved together to Ashtabula, Ohio, near Lake Erie. Howard's parents eventually divorced when his father moved to Virginia for work, although his father remained in touch until his death in the 1920s. In 1894, at the age of nine, Howard's mother remarried to a man named Leander Blackwell, who, as a medical doctor himself, may have influenced Howard's career path.
Knox met his wife, Marion Dorothy Henderson, while he was at his first job after graduating from medical school. Little is known about Marion, other than that she was the third cousin of Knox's mother's side of the family. Knox and Marion were married in 1906, and divorced in 1910 after Knox's ailing mother moved in with the married couple, which led to a marital dispute.
In early 1911, Knox took leave from the Army to marry Gladys Barnett Reed, a woman of family wealth from Brooklyn, New York.The Journal of The American Medical Association, 56:1 Details of how they met are unknown, but it is clear that by marrying Gladys, Knox advanced into a higher social class. They had a daughter, Dorothea, on October 28, 1911; and a second daughter, Gladys Sprague Knox, on January 24, 1913. In 1914, Howard and Gladys Knox divorced.
Knox married Maka Harper in 1916 and had a daughter, Carolyn Knox (later Carolyn Knox Whaley), and two sons, Howard Knox and Robert Harper Knox.
Education
After graduating from high school in Willimantic, Connecticut, Knox enrolled in the Medical School at Dartmouth College in Hanover, New Hampshire. Only a few months after enrolling, his stepfather was killed in a tragic accident involving a freight train at a railway crossing, for which his mother later brought suit against the Central Vermont Railway CompanySupreme Court of Connecticut Third Judicial District (1906). Metcalf v. Central Vermont Railway Co., New Haven, CT. Compounding this loss, Knox's grandfather also died several months later, and he withdrew from his studies at Dartmouth for a period of time to help his mother. He returned to his studies and received his medical doctorate on March 27, 1908.
While in medical school, Knox had completed some specialization in psychiatry. Upon graduating he took a staff job at the Worcester Insane Hospital, in Worcester, Massachusetts, near his mother. Although the hospital had originally been a promising model for many institutions, by the time Knox took the job, it was in deep decline.Mora, G. (1969). Gerald Grob. The State and the Mentally Ill. A History of Worcester State Hospital in Massachusetts, 1830–1920. Chapel Hill: Univ. NC Press, 1966, pp. XV+ 399
However, a new opportunity opened for Knox, when in 1908 Congress approved a reorganization of the Army's medical department, officially designating the Army's regular physicians within the Medical Department as the Medical Corps. In order to be trained in the area of military medicine, physicians were called to become part of the Army through the Medical Reserve Corps.Stewart, R. W. (2005). American Military History: The United States Army and the forging of a nation, 1775-1917. Government Printing Office. Knox applied to this program several months later and was accepted into the Medical Reserve Corps with the rank of first lieutenant.
Career
US Army (1908-1911)
Knox began his military career as a surgeon at Fort Michie, on Great Gull Island in Long Island Sound, off of New London, Connecticut. Most coastal forts, especially those that were relatively isolated from major cities (like Fort Michie), had their own hospitals. Knox and his wife arrived at Fort Michie on October 3, 1908 and lived there for about a year. It was here that Marion gave birth to their daughter, Violet in 1909; however, Violet was not healthy and died within a few months.
After receiving high reviews from his commanding officer in 1909, Knox decided to seek a position at the Army Medical Corps. To do so, he underwent training for one year at The Army Medical School in Washington, D.C. After a year, he graduated forty-fourth in his class of fifty-four students in April 1910. His first station was as an assistant to the general surgeon at Fort Hancock in New Jersey. That summer, he made first lieutenant in the U.S. Army Medical Corps. Not long after, Knox's mother became sick and moved in with him and Marion. A matrimonial dispute occurred, which is not well documented, but it is clear that Marion left and later filed a complaint with the War Department stating that Knox had left her and failed to provide financial support. He claimed that Marion refused to live with him unless his mother left the house. The War Department was satisfied with this response and determined that no action would be taken; however, it has been suggested that this event may have colored Knox's reputation with the Army.
In the summer of 1910, Knox was placed at Fort Ethan Allen, which had opened only three years earlier in 1908 near Lake Ontario, as an Army training center.Roberts, R. R. 1988. Encyclopedia of Historic Forts: The Military, Pioneer, and Trading Posts of the United States. New York: Macmillan. During his first month, he worked at the stationary hospital at Pine Camp, which would have served those injured during training at Pine Camp.McKee, S.H. 1919. The work of a stationary hospital in the field. Canadian Medical Association Journal, 9:49-51. During his time here he did take ten days leave to return to Fort Hancock where he again served as the assistant to the general surgeon. Here he drafted his first publication, a brief case report on a young patient with filariasis.Knox, H.A. 1911. Filariasis at Fort Hancock, New Jersey. Military Surgeon 28 (June):659-60 In January 1911, Knox took an official leave from the Army to marry Gladys Barnett Reed
After Fort Ethan Allen, Knox was assigned as assistant to the surgeon at the infirmary of the Third Provisional Regiment in Fort Crockett, which had recently reopened after sustaining hurricane damage in 1900. Here he was on duty beginning March 18, 1911. In April however, he requested to be restationed at Fort Hancock near his mother, to assist her as she needed to have surgery. Although his commanding officer supported his transition, the paperwork was not received by the adjutant general until nearly a week later. The surgeon general was consulted, who had previously been the president of the Army Medical School during Knox's enrollment and had written a positive evaluation for him then. However, at this time, he noted that several events had rendered Knox's future with the Army to be uncertain, and thus recommended resignation. Knox officially resigned from the Army at the end of April, 1911.
Civilian career
After leaving the Army, Knox and his wife moved to Sheffield in Berkshire County, Massachusetts. Here, he started his own practice as a general physician. In 1910, lectures given by Sigmund Freud and Carl Jung were published in the American Journal of Psychology, and their work was well known among psychologists as well as medical doctors during this time. Knox was among those interested physicians, and he showed an interest in intelligence.
His first article on the topic was published in 1913 in the Journal of the American Medical Association,Knox, H.A. 1913. The moron and the study of alien defectives. Journal of the American Medical Association (January 11): 105-106. in which he demonstrated not only an interest in intelligence testing but also in its cultural sensitivity. In this article, Knox focuses on the differentiation between those with "mental aberration" or active insanity, versus those "mental defectives" classified as "morons and constitutional inferior types." During this time, Alfred Binet was publishing his research on intelligence testing.Binet, A. 1903. The experimental study of intelligence. Paris: Schleicher.Binet, A. 1911. New research on the measurement of intellectual level in schoolchildren. In this JAMA article, Knox draws reference to Binet's research and the development of intelligence tests during the time. He pointed out that although intelligence tests can differentiate the less intelligent, less well developed class of people, if administered to individuals from another culture or country, the individuals might be incorrectly classified as morons. He wrote, "if these peasants are questioned about conditions existing in the land from which they come, most of them will show average intelligence."
Knox continued to show interest in psychology in his next article, also published in 1913.Knox, H.A. 1913. Some practical psychotherapy. Journal of the American Medical Association, 60: 105-106. In this article he wrote about a case he had seen in Sheffield, a man who had persistent persecutory delusions. Knox stated that for a period of time, he had listened to this man recount his delusions and wrote down the details in his notebook. After a period of time, the man appeared to recover; and Knox believed that by writing down his delusions, he had validated the patient which contributed to his improvement.
In October 1911, Knox attempted to rejoin the Army and applied to the office of the surgeon general for readmission. His application was received in 1912, but his application was not well received. Although it is not clear precisely why Knox fell out of favor of the Army, there are several possibilities. It is possible that his discovery and reported treatment of rampant venereal disease while at Fort Hancock was frowned upon, as at the time venereal disease was quite stigmatizing and his treatment of it might have been considered immoral. It is also possible that the rapid dissolution of his marriage to Marion, and quick remarriage to Gladys, painted him as an unreliable man. In any case, he was not permitted readmission to the Army.