In memory of Dr. Knox Ritchie

It is with great sadness that we announce the loss of our friend and colleague, Dr. Knox Ritchie. As Chair from 1991 to 2003, Knox served as an inspirational leader, transforming the Department of Obstetrics and Gynaecology into the thriving centre of excellence in which we all flourish today.

Knox passed away peacefully in Penetanguishene, Ontario on July 14, 2022, aged 78. The Knox whom we will all fondly remember grew up in Belfast, Northern Ireland. His father was a family physician and both Knox and his younger brother, Alan, followed in their father’s footsteps to Queen’s University, where Knox obtained his medical degree in 1968. Interestingly, his brother Alan also became an obstetrician-gynaecologist and practised in Northern Ireland. As a student, Knox was a keen athlete, representing Ireland both as a swimmer and water polo player. Midway through his clinical training, Knox spent time as a clinical registrar in Harare, Rhodesia (now Zimbabwe), and subsequently undertook his MD doctoral research training in fetal physiology at the Nuffield Institute for Medical Research at Oxford University in England with the late Geoffrey Dawes.

Knox returned to Belfast to complete his postgraduate training in the newly emerging field of maternal-fetal medicine (MFM) as a clinician-scientist. The early 1980s was a very exciting time in obstetrics, with the development of Doppler ultrasound as a potential clinical tool. Knox was one of the pioneers who realized the significance of abnormal umbilical artery waveforms in small fetuses and was fascinated to understand the underlying mechanisms. With the worldly influences gleaned from his time in Africa and the international academic community that he became part of in Oxford, he saw the tremendous potential on offer to him when he was enticed to move across the Atlantic to start a high-risk pregnancy program at Mount Sinai Hospital. Arriving with his wife Doris, daughter Jayne and son Martin in 1984, Knox quickly deployed his renowned skills as an inspirational recruiter of physicians, scientists and specialty nurses.

With the full support of the hospital and Fred Papsin, chief of obstetrics and gynaecology, Knox set about transforming his vision into a reality. He recruited Lee Adamson from the University of Western Ontario to direct a new sheep fetal physiology program at Mount Sinai Hospital, where classic experiments involving microsphere embolism into the fetal umbilical circulation produced the same abnormal Doppler waveforms as he had observed in the human growth-restricted fetus. Presented and published as a first author by Robert Morrow, one of Knox’s first MFM fellowship trainees, in the American Journal of Obstetrics & Gynecology in 1989, this widely publicized achievement set the scene for the upward trajectory of reproductive sciences under Knox’s leadership.

In parallel, Knox successfully recruited Stephen Lye, also from London, Ontario, to develop a myometrial physiology and preterm birth prevention group within the newly created Samuel Lunenfeld Research Institute. In tandem, Knox mentored two emerging reproductive scientists, namely Isabella Caniggia (to form a placenta and preeclampsia research group) and Jay Cross (to open a developmental biology laboratory focusing on mouse models of early placental development). Two internationally renowned reproductive physiologists, John Challis and Stephen Matthews, each moved to the Department of Physiology at the University of Toronto from the University of Western Ontario. In turn, each served as chair of that Department and was very supportive of Knox’s vision. By the mid-1990s, Knox had skilfully masterminded the formation of one of the world’s most renowned groups of reproductive scientists, recognized through a series of five-year Canadian Institutes of Health Research (CIHR) grants in development and fetal health. Quoting John Challis, Knox was “a facilitator and catalyst – always generous of mind, spirit and his time.” It was in this exciting environment that John Kingdom was recruited by Knox to join this talented group from University College London in the United Kingdom in spring 1998.

Knox was always a very talented and grounded clinician who saw the equal importance of strengthening the clinical department and the need to create an MFM Division of international stature. Another Irishman, Greg Ryan, moved from Winnipeg to be another one of Knox’s early MFM fellows. Knox then encouraged him to pursue a two-year McLaughlin Fellowship in fetal therapy in the U.K., based initially in Glasgow and subsequently at University College London. Greg returned, empowered to develop a fetal diagnosis and therapy program, which to this day has blossomed into the internationally renowned Ontario Fetal Centre in partnership with The Hospital for Sick Children. Knox also persuaded his long-time friend and colleague Ron Livingstone to relocate to Toronto and lead the Divisions of Obstetrics and Maternal-Fetal Medicine at Toronto General Hospital. Knox was always modern in his thinking and is credited for supporting the recruitment of female faculty members in MFM, including Jo-Ann Johnson to Toronto General Hospital and Kellie Murphy to Mount Sinai Hospital. In tandem, he trained Twila Tice and Colleen Anastasiadis as his first high-risk pregnancy nurse sonographers, establishing a niche specialty previously unknown in Canada, which has since blossomed and thrived. He was also an enthusiastic supporter of the development of midwifery services in Ontario.

Amongst many brilliantly executed moves, in 1999, Knox seized on the opportunity to merge obstetrics and gynaecology services between Toronto General Hospital and Mount Sinai Hospital into the Sinai Health System we all know today. He recognized the synergy that such a move would create as the programs were highly complementary, and achieved this merger with the loyal support of Ron Livingstone, who then joined his leadership team at the Sinai site. The equally prestigious medical diseases of pregnancy program, developed by Mathew Sermer, moved along with programs in reproductive genetics (led by David Chitayat) and prenatal diagnosis and ultrasound imaging (led by Jo-Ann Johnson and Ants Toi) to complete the equivalent of a philharmonic orchestra in high-risk obstetrics. He chose Mathew Sermer to lead the newly merged MFM Division in 2000. 

Like a well-planted vineyard, Knox knew then that his main role as chair and chief was to mentor, encourage and celebrate his colleagues and successive waves of trainees. This he did with brilliance. He served as obstetrician-gynaecologist-in-chief at Mount Sinai Hospital and as chair of the Department of Obstetrics and Gynaecology at the University of Toronto, with great distinction during the period 1991-2003. The MFM fellowship program that Knox started and fostered has had an enormous impact internationally, graduating more than 150 trainees from more than 40 countries. Many of these former fellows have returned home to initiate and develop MFM programs, and several have gone on to become department chairs and national leaders in high-risk pregnancy care. 

Never forgetting his worldly view of life, Knox subsequently accepted the opportunity to be MD program coordinator for obstetrics and gynaecology at the Royal College of Surgeons in Ireland-affiliated Medical School at Penang, Malaysia during the period 2012-2016. Together with his new partner, Libby, a medical school classmate, this opportunity gave them a completely new perspective on the world, travelling extensively throughout South Asia. Eventually, he returned to his new home at Tiny Beach in Southern Georgian Bay, where he lived an active retirement, surrounded by close friends, enjoying sailing, golf and some of the best sunsets on offer in Ontario.

Born and raised in Northern Ireland, during a conflict that he saw largely end with the Good Friday Agreement in 1998, Knox was the ultimate Irish gentleman, highly respected as an academic leader in obstetrics and gynaecology across both sides of the Irish border, and throughout Britain. His bold move to Canada, with the full support of his wife Doris, has since had a profound effect on the careers of many individuals, many of whom have been proud to continue in their academic service in this world-class Department that he fostered. His inspirational leadership in reproductive sciences and in MFM brought him many friends and deep respect worldwide.

Knox leaves behind his beloved partner Libby, his daughter Jayne (Joe), his son Martin (Diana), their mother (Doris) along with their five grandchildren (Ella, Jack, Scarlett, Alfie and William; all born safely at his chosen home of Mount Sinai Hospital), and his brother Alan and sisters Alison and Caroline.

Knox, rest in peace, our beloved colleague, mentor and friend.   

John Kingdom 
Chair, Department of Obstetrics and Gynaecology, University of Toronto

Greg Ryan
Head, Ontario Fetal Centre

Mathew Sermer
Chief of Obstetrics and Gynaecology, Sinai Heath

Stephen Lye
Interim Director, Lunenfeld Tanenbaum Research Institute