Charles Aston Key

Charles Aston Key was the son of the physician Thomas Key. He became apprenticed to his father in 1810, then studied at the Royal College of Surgeons, and in 1815 became apprenticed to Astley Paston Cooper (1768-1841), whose niece – the sister of Bransby Cooper – he later married. He became a member of the College of Surgeons in 1821, commenced his practice, and was chosen by Astley Cooper to give the anatomical lectures at St. Thomas’s Hospital. In 1823 he became assistant surgeon at Guy’s Hospital, where, with John Morgan (died 1847), he was chosen to give the lectures on surgery.

Key soon earned himself a reputation as a highly skilled/dextrous operator, publishing many works on the topic. He became particularly known for introducing the principle of dividing the stricture outside the sac in cases of strangulated hernia – herniotomy – without opening of the hernial sac.

After becoming senior surgeon to Guy’s Hospital in 1833, he took an active part in the publishing of the Guy’s Hospital Reports from its first edition in 1836. In this first volume he published 7 memoirs. An excellent teacher and surgeon, Key enjoyed the general respect of his colleagues, who in 1845 elected him member of the Royal College of Surgeons. He had a busy and lucrative practice and was appointed surgeon to Prince Albert. He fell victim to the cholera after only one day of illness in 1849.

In 1830 William Key, with Sir Astley Paston Cooper (1768-1841) and Mr. Callaway, performed an operation causing a lot of attention. He reported on this in Lancet 1830-1831, pp. 86-89.

“Hoo Loo, a Chinese labourer, was admitted into Luke’s ward, Guy’s Hospital, in the third week of March last year, with an extraordinary tumour depending from the lower part of the abdomen, and of a nature and extent hitherto unseen in this country. He had been brought to England from canton, by his own desire, in an East Indiaman, for the purpose of having this tumour removed at one of the London Hospitals, the native surgeons declining to make the attempt, a general disinclination to the performance of serious operations prevailing in the East, where both the climate and the law offer important objections to surgical proceedings which may lead to the loss of human life. The case excited considerable interest, both in and out of the profession, from the first moment of his arrival, and he was visited in the hospital by a great number of persons of all ranks. . . .

It was generally understood that the operation would be performed on Tuesday last, but so great a crowd of spectators was apprehended, that Saturday, which is a dies non in the hospital, was fixed on instead. Notwithstanding this precaution, however, an assemblage, unprecedented in numbers on such an occasion, presented themselves for admission at the operating theatre, which was instantly filled in every part, although none but pupils, and of those only such as could at the moment present their "“hospital tickets," were admitted. Hundreds of gentlemen were consequently excluded, and it became obvious to the officers of the hospital, that some other room must be selected. Accordingly Sir Astley Cooper entered, and, addressing the pupils, said, that in consequence of the crowd, the patient being in a state which would admit of the removal, the operation would take place in the great anatomical theatre. A tremendous rush to that that theatre accordingly took place, where accommodation was afforded to 680 persons, and where preparations were immediately made for the patient. In about a quarter of an hour, Hoo Loo entered, accompanied by two nurses and a posse comitatus, consisting of various functionaries of the hospital, and in the course of a few minutes he was secured on the operating table. A short consultation now took place between Sir Astley Cooper, Mr-Key, and Mr. Callaway, during which it was finally agreed, that if it were found possible, the genital organs should be preserved. The face of the patient was then covered, and Mr. Key, taking his station in front of the tumour, commenced the operation . . .”

The poor patient, however, did not only loose his penis, but his life as well, death being ascribed to hæmorrhage:
“. . .Complete syncope occurred twice, and during the whole of the later steps of the operation he was in a state of fainting. The quantity of blood lost was variously estimated by those who assisted, and though certainly not large, it was the operators own impression that the hæmorrhage was the immediate cause of death . . .
. . . No remedies that were directed to overcome this state of collapse had the slightest effect; warmth and friction of the extremities, warmth to the scrobiculis cordis, the injection of brandy and water into the stomach, and, ultimately, from the suspicion that the loss of blood had been too great, transfusion to the amount of six ounces, taken from the arm of a student – one amongst several who offered to afford blood – were amongst the means resorted to. The heart’s action gradually and perceptibly sunk. The patient did breathe after the operation, but that is as much as can be said. Artificial respiration was subsequently, but vainly attempted.”

“Hoo Loo was 32 years of age, and the tumour had been ten years arriving at its present growth . . . The weight of the tumour was conjectured to be about seventy pounds, but when placed in the scale after its removal it weighed by fifty-six. His strength was not affected by it. He could take a stout lad in his arms and toss him with ease.”

• A short treatise on the section of the prostate gland in lithotomy; with an explanation of a safe and easy method of conducting the operation on the principles of Cheselden.
  London, 1824, with 4 plates.
• Case of axillary aneurism successfully treated by tying the subclavian artery.
  Medico-Chirurgical Transactions, London, 1825.
  In 1823 Key successfully ligated the subclavian artery for aneurysm at the axilla.
• On chronic enlargement of testicle etc. London Medical Gazette, 1829.
• Removal of a tumour fifty-six pounds in weight, extending from beneath the umbilicus to the anterior border of the anus.
  Lancet, London, 1830/1831, I: 86-89.
• Aneurysm of the arteria innominata, operation by tying the carotid; sudden death; singular pathological appearances.
  London Medical Gazette, 1830.
• A memoir on the advantages and practicability of dividing the stricture in strangulated hernia on the outside of the sac etc.
  London, Longman, 1833, with 3 plates.
  Introducing the principle of dividing the stricture outside the sac in cases of strangulated hernia – herniotomy – without opening of the hernial sac.
• Femoral aneurism successfully treated by a ligature of the external iliac artery.
  Guy's Hospital Reports, London, 1836, 1: 59-78.