Thomas Keith

Several surgeons have achieved fame in fields not connected with surgery. Foremost among those was Thomas Keith, a pioneer of ovariectomy and a pioneer of photography. Apprenticed to Sir J Y Simpson, he was to be the last medical apprentice in Edinburgh, and went on to become the pre-eminent gynaecological surgeon of his day, whose results for the new operation of ovarian cystectomy were amongst the best in the world. Other pioneers in the field, Spencer Wells and Marion Simms, wrote in glowing terms of his skill and pre-eminence. Yet his extensive and glowing obituaries in the medical journals made no mention of his distinguished achievements in another area. Thomas Keith was a pioneer of photography in Britain and his pictures demonstrate both scientific application and artistic flair.

Thomas Keith was born son of the Manse in the village of St. Cyrus five miles north of Montrose on the North Sea coast of Angus in Scotland. After schooling at Aberdeen Grammar School and Marischal College, Aberdeen, he embarked on a surgical career becoming apprentice to James Young Simpson in 1845. He had the distinction of being the last medical apprentice in Edinburgh.
Appointed resident surgeon to James Syme in the Edinburgh Royal Infirmary, he had reason to be grateful to Syme for, early in life in Aberdeen he had developed bladder calculi which dogged him throughout his life. He had a urethrotomy for stones as a boy and in the 1860s Syme operated on two occasions to remove further calculi. In 1889 just six years before his death his brother George, also a surgeon, drained a perinephric abscess but the sinus continued to discharge for the rest of his life. In spite of continuing episodes of pain and sepsis he maintained rigorously high surgical standards for his patients.

After his apprenticeship he was appointed surgeon to the British Ambassador at the Court of the King of Sardinia in Turin where he stayed for two years. During this time he published a paper in a local medical journal deploring the then prevailing custom of copious blood letting for a variety of ailments.

Returning to Edinburgh he joined his brother, Dr. George? Skene Keith, in practice devoting himself increasingly to gynaecological surgery. He visited Sir Spencer Wells, the pioneer of ovarian cystectomy in London and in 1862 performed his first ovarian cystectomy. He went on to become one of the most successful surgeons in the world at this procedure. His success was based on an obsessional attention to detail and contemporaries described his patience, neatness and unhurried technique. Another pioneer of gynaecological surgery the American Marion Simms wrote that “his success so far overtopped that of all other surgeons that it became a wonder and admiration of surgeons all over the world”. In 1877 he began to take advantage of Listerian antisepsis and was able to publish a 97% recovery rate following ovarian cystectomy. He went on to pioneer hysterectomy for bleeding fibroids where his success was again as good as any in the world.

Keith published a series of articles which formed the basis of his book “Contributions to the Surgical Treatment of Tumours in the Abdomen”. His pioneering work in cautery in abdominal surgery was described in a further book “Electricity in the Treatment of Uterine Tumours”. Both his sons joined him in surgical practice and encapsulated much of his work in “A Textbook of Abdominal Surgery” published in 1894.

His contemporaries describe a meticulous surgical technique and courage in pursuing a conservative course when he felt that surgery might not be most appropriate. Keith had a striking appearance - a tall thin figure with a high broad forehead, a shock of reddish brown hair, and a thin aesthetic face. Contemporaries described him as abnormally conscientious with an intense feeling of personal responsibility for patients. Marion Simms was to write “his whole being is wrapped up in his work and after he has performed a difficult operation he eats and sleeps but little until he knows that his patient is out of danger”.

In later life he was to follow Lister and Mathews Duncan to London. The young Lister had followed him as resident to Syme and the two had remained friends throughout their lives. Keith was one of the first to promote the benefits of Listerian antisepsis.

Yet his surgical colleagues seemed to have been quite unaware of his distinction as a pioneer in the developing art of photography. His introduction to photography had come within a few months of Talbot’s announcement and the latter’s patent of the Calotype in 1841. Unrestricted by that patent, Keith developed his own technique by meticulous experiment. At the Disruption in 1843 his father, Dr. Alexander Keith, left the Church of Scotland to join the newly established Free Church, and the photographic pioneer, Dr. Octavius Hill, decided to commemorate this event with a large series of early photographs. Keith’s father Alexander and his brother George produced Daguerreotypes on a visit to Palestine which illustrated Alexander Keith’s book “Evidence of the Truth of the Christian Religion” which became a classic and was produced in over 40 editions. Thomas Keith had equipped himself as a photographer in 1852 but the time involved in the exposure restricted his photographic activities to midsummer and early autumn. He went on to produce romantic compositions of Edinburgh town scenes. His work was included in 1854 in Edinburgh’s first photographic exhibition alongside photographs by Octavius Hill, Adamson, and George Washington Wilson. Keith’s work was highly praised in his own lifetime. Photographic historians have recognised his superb use of light, his flair for composition which result in his photographs becoming bold individual statements. As with his surgery it was his meticulous attention to detail that made him a photographic pioneer in his own right. All of this was achieved in a short photographic career in Edinburgh between 1852 and 1857.