Tuesday, June 18, 2019

Keynes, Geoffrey - St Bart's

Sir Geoffrey Langdon Keynes (25 March 1887, – 5 July 1982) was an English surgeon and author. He began his career as a medic in World War I, before becoming a doctor at St. Bartholomew's Hospital in London, where he made notable innovations in the fields of blood transfusion and breast cancer surgery. Keynes was also a publishing scholar and bibliographer of English literature and English medical history, focussing primarily on William Blake and William Harvey.

Geoffrey Keynes delayed his medical education in order to serve in World War I, where he served as a Lieutenant in the Royal Army Medical Corps and then worked as a consultant surgeon, becoming an expert in blood transfusion. His experience in the First World War led him to publish Blood Transfusion, the first book on the subject written by a British author. Keynes also founded the London Blood Transfusion Service with P. L. Oliver. Keynes was deeply affected by the brutality and gore that he witnessed in the field, which may have influenced his dislike for radical surgery later in his career.

After returning from World War 1, Keynes began working full-time at St. Bartholomew's Hospital in London, where he worked under George Gask and Sir Thomas Dunhill. Keynes used his influence as an assistant surgeon to advocate for limited surgery instead of the invasive radical mastectomy. Frustrated with the mortality rate and gruesomeness of the radical mastectomy, Keynes experimented by inserting fifty milligrams of radium in a patient's tumor. He later observed that, "The ulcer rapidly healed ... and the whole mass became smaller, softer and less fixed."

Keynes pursued his new idea through a number of trials, observing the effectiveness of injecting radium chloride into breast cancer tumors compared with the effectiveness of the radical mastectomy. The promising results of these trials led Keynes to be cautiously optimistic, writing in 1927 that the "extension of [an] operation beyond a local removal might sometimes be unnecessary." Keynes' outlook was considered a radical break from the medical consensus at the time. Keynes wrote in his autobiography that his work with radium "was regarded with some interest by American surgeons," but that the concept of a limited mastectomy failed to gain significant traction in the medical community at the time. His doubts regarding the radical mastectomy were vindicated some fifty years later, when innovators like Bernard Fisher and others revisited his data and pursued what became known as a lumpectomy. Limited surgeries, like the lumpectomy, accompanied by radiation are now the status quo in breast cancer treatment.

Keynes also a pioneer in the treatment of myasthenia gravis. Much like with breast cancer, the medical community knew very little about how to treat the disease at the time. Keynes pioneered the removal of the Thymus Gland, which is now the norm in treatment of myasthenia gravis.

Keynes enlisted to be a consulting surgeon to the Royal Air Force at the outbreak of World War II. In 1944 he was promoted to the rank of acting air vice-marshal.

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