Robert Lawson Tait
- Tait's law
- Tait's ligature
- Tait's operation
- Tait's operation II
- Tait-Porro operation
- Tait-Porro operation
English gynaecologist, born May 1, 1845, Edinburgh, Scotland; died June 13, 1899, country estate Llandudno, North Wales.
Biography of Robert Lawson TaitRobert Lawson Tait was the son of Archibald Campbell Tait, of Dryden, who was a cousin of the Archbishop of Canterbury with the same name. His father was a Guild Brother of Heriot's Hospital; his mother was Isabella Stewart Lawson, of Leven. Robert was their second son, born on Frederick Street, Edinburgh on May 1, 1845. From the age of 7 Lawson Tait was educated at Heriot's Hospital School, Edinburgh. At the age of 15, with a scholarship, he began to study Arts at the University of Edinburgh. However, he abandoned the arts course after his first year, and never graduated.
In 1862 he was apprenticed to Alexander McKenzie Edwards, the Extramural Lecturer on Surgery, and for six years acted as his assistant after he qualified as a Licentiate of the Royal College of Surgeons at the age of 21, in 1866. During his student career he became a favourite with James Syme (1799-1870), the inventor of the Mackintosh, and Sir William Fergusson (1808-1877) and for some time lived in Sir James Young Simpson's (1811-1870) house. A part of Tait legend is a rumour that he was the son of Sir James Young Simpson, but there is no evidence to support the rumour.
He left Edinburgh in 1866, visited Dublin and other schools of medicine. In 1867 he was appointed House Surgeon to the Wakefield Hospital, Yorkshire. In 1867 Tait took up his appointment as the only house surgeon at the 12-bed Clayton Hospital, the centre of the Wakefield General Dispensary. There were many out-patients to be attended to and a large number of patients were visited in their own homes.
On July 29, 1868, he performed the first of his five ovarotomies as a house surgeon. Tait had seen 30 ovariotomies performed in Edinburgh without a single recovery, and according to McKay, this being so, “it must have required considerable courage on the part of Tait to tackle his first ovariotomy.” This patient, aged 26, died of peritonitis. In May of the same year, 1868, he had opened the abdomen of a woman of only 37 to find a ”unilocular ovarian cyst, complicated by general cancer of the peritoneum.” This patient survived the operation but lived only for a month. These two cases might have daunted most house surgeons, but Tait went on to record in 1872 what he had said to himself was ”the whole of my experience ”–nine cases, including the first fatal one, all the remaining eight being successful.
These figures attracted attention, because Tait was unknown and because they were supplied in response to an appeal by the British Medical Journal for recent records of cases of ovariotomy. In making this request the Journal tabulated the figures available up to that time. Up to 1866, St. Bartholomew’s, the Middlesex, King’s College, St. George’s and University College Hospital had had between them 30 cases in which ovariotomy had been performed. There were nine recoveries and 30 deaths. Guy’s was the more fortunate, for there Braxton Hicks had operated on 44 cases with only 21 deaths. Better still were the results obtained by Mr. Spencer Wells at the Samaritan Hospital. Between 1858 and 1867 he had operated on 106 patients with 30 deaths.
Then from 1868 to 1871 he had had a further 97 cases with 25 deaths. In other words, Spencer Wells was the outstanding ovariotomist with over 200 cases and a mortality of 27 per cent. Only Keith in Edinburgh had anything like the same experience.
In September 1870, at the age of 25, Tait acquired the practice of Dr. Thomas Partridge in Birmingham, and settled in that city. He joined and attended regularly the local medical societies. He was lecturer in physiology at the Midland Institute from 1871 to 1879 and his whole-hearted advocacy of Darwin’s theory of evolution attracted attention and opposition. George Dawson founded and edited the Birmingham Morning News, and Tait wrote leading articles there from 1871 until the paper died in 1876.
Tait wrote regularly for the medical journals and he supplemented his income from practice by writing leading articles for George Dawson, a famous preacher and lecturer. Tait soon made a name for himself as a bold surgeon, an original thinker, and an aggressive enemy. In 1871 he was the founder of the founders of the Birmingham and Midland Hospital for Women, an institution devoted entirely to ‘the alleviation of diseases peculiar to women’. He became one of the three Chief Surgeons. In the same year he married Sibyl Stewart, whom he had met in Wakefield. It is ironic in the light of his specialty, and rather sad, that he and his wife had no children.
He was Lecturer on Physiology at the Midland Institute from 1871-1879, where his advocacy of the Darwinian theory of evolution excited considerable opposition.
Tait took rooms in the centre of Birmingham, gave up general practice, and at the age of 26 began practice as a consulting surgeon without holding a hospital appointment. This was early in 1871 and his rooms were in Waterloo Street. Immediately he began to press for the establishment of a special hospital for the Diseases of women. In this he was assisted by Arthur Chamberlain and opposed by The Lancet. Right from the start Tait showed what the British Medical Journal later described as ”a want of respect for age and authority remarkable even in Birmingham.” He possessed, too, the kind of ruthless courage which we more often associate with the outstanding surgeons of the pre-anaesthetic era. These are two important keys to his character and his remarkable success. Once Tait opened an abdomen, if it was humanly possible he went on to complete whatever surgical procedure was necessary.
The newly founded Birmingham Hospital for Diseases of Women achieved world fame for Tait’s operations. He held this his position at this hospital until 1893, when he was elected a member of the Consulting Staff. He performed two operations of historic importance in 1872: the first on February 2nd, when he removed a suppurating ovary; the second on August 1, when he extirpated the uterine appendages to arrest the growth of a bleeding myoma. He did his first hysterectomy for uterine myoma in 1873, following, with slight modifications, Eugène Koeberlé's technique, and in June, 1876, he removed a haematosalpinx and thus made the profession familiar with the pathology of the condition.
Tait was a vociferous, often demeaning critic of Lister and his experimental research. He was never convinced of the pathogenic nature of bacteria and in 1878 began to express doubts as to the value of the Listerian carbolic acid spray then generally employed by surgeons in abdominal operations.
Iinstead he used soap and water to wash his hands thoroughly. His instruments were boiled and his linen laundered.
He tended to use a small incision and post operatively he removed excess blood from the abdomen and used a peritoneal ‘wash-out' of boiled water. The operations were performed quickly to reduce the risk of infection. Most of his operations were performed in the Crescent, the small hospital for women in Birmingham, or at the patients own home.
In 1880 he was the first British surgeon to diagnose acute appendicitis and to treat it by removal of the appendix. On Jan 17th, 1883, he first performed the operation for ruptured tubal pregnancy and saved the patient. A series of thirty-five cases with only two deaths speedily followed, and the operation took its place as a recognized method of treating a condition which had previously been looked upon as desperate.
Tait' had success with his demonstration that ovariotomy could be done safely. While Ephraim McDowell (1771-1830) had successfully performed the first ovariotomy in Kentucky in 1809, mortality for this operation was over 90%. In his first paper in 1872, Tait reported only 1 death out of nine cases, a major breakthrough. His techniques of use of intraabdominal ligatures for the ovarian pedicle in favour of an extraperitoneal clamp, abdominal closure, and meticulous surgical cleanliness were novel and important for abdominal surgery.
In 1881, it was suggested to him to remove the ruptured tube in case of an ectopic pregnancy. "... the suggestion staggered me, and I am ashamed to say that I did not receive it favourably." The postmortem examination convinced him that it could be done. So, 2 years later, Tait ligated the broad ligament and tube in another patient, and this patient survived. In 1888, Tait reported only 2 deaths out of 42 operated cases, a marked improvement for a condition that had been almost always fatal.
Tait, a self-proclaimed gynaecologist, is perhaps most widely known as the first to perform salpingectomy to treat ruptured tubal pregnancy. He was also the first to record removal of an ovary for relief of pelvic pain and to induce menopause, perform salpingectomy for the treatment of tubal disease, and develop the technique of transverse transperineal repair of low rectovaginal fistulas. His scrupulous cleanliness was undoubtedly the forerunner of our modern aseptic methods. Tait's bold, innovative surgical techniques led to a significant decrease in surgical mortality, and his prescient, aggressive approach was at the forefront of changes in the practice of obstetrics, which resulted in a marked decrease in maternal morbidity and mortality.
In 1890 he reported the performance of caesarean section in cases of placenta previa.
Tait also distinguished himself in the field of plastic operations, through his introduction of flap splitting, which was not entirely his own concept, and the operation for complete intestinal rupture (Darmrisse), called the Lawson Tait operation (J. Obstetr., 1879-1880, 7: 585). He also concerned himself with the surgery of other abdominal organs, particularly the liver and gallbladder, and in 1884 introduced cholecystomy. Besides a series of new operational methods, he also devised a number of new surgical instruments, and improved some of the existing ones.
Independently of the American surgeon Robert Battey (1828-1895) and the German surgeon Ernst Ludwig Alfred Hegar (1830-1914), and at at the same time as they, he perfomed a removal of the ovaries (British Medical Journal, London, 1879, I, page 813), and as early as in 1880 he performed the ventrofixation of the retroflected uterus.
Tait was a strong opponent to animal experimentation. His comment: " ...after we have found out what (experimental drugs) do in one animal we find that in another the results are wholly different and the process of investigation has to be repeated in man."
Tait was active as a citizen of Birmingham, elected member of the City Council in 1876, becoming Chairman of the Health Committee and a member of the Asylums Committee. He stood for Parliament in 1887 as a Gladstonian Liberal in Unionist Birmingham and was heavily defeated by Mr. Jesse Collings. In the following year he was elected the first Professor of Gynaecology in Queen’s College, Birmingham. He created what was called the ”Birmingham School of Gynaecology.”
Tait was a fellow of the Royal College of Surgeons of Edinburgh honoris causa as well as of the Royal College of Surgeons of England. He was also a prominent member of many scientific societies – and took a leading part in establishing coffee-houses in Birmingham.
Tait received many honours. In 1873 he was awarded the Hastings Gold Medal of the British Medical Association for his essay "On Diseases of the Ovaries", and in 1890 he received the Cullen and Liston Triennial Prize at Edinburgh for his services to medicine, especially in connection with his work on the gall-bladder. This prize, which was afterwards exhibited in the Art Gallery at Birmingham, consisted of a silver bowl of seventeenth-century London workmanship.
Late in life Tait was involved in several controversies that marked his downfall. The most serious of these were from a woman who claimed he was the father of her daughter.
The last five years of Tait's life were marked by almost continuous ill health, which caused him to relinquish much of his operative work and seek repose at Llandudno, where he had bought a house. He died there from uraemia on June l3th, 1899.
When in doubt, drain.
Quoted in Archives of Surgery, 1964, 89: 686.