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Biographical entry Tait, Robert Lawson (1845 - 1899)

MRCS Jan 25th 1870; FRCS June 8th 1871; LRCP LRCS Edin 1866.

Born
1 May 1845
Edinburgh
Died
13 June 1899
Llandudno
Occupation
General surgeon and Gynaecologist

Details

Born at 45 Frederick Street, Edinburgh, on May 1st, 1845, the son of Archibald Campbell Tait, of Dryden, a Guild Brother of Heriot's Hospital, and of Isabella Stewart Lawson, of Leven.

From the age of 7 Lawson Tait was educated at Heriot's Hospital School, Edinburgh, until he entered the University with a scholarship in 1860. He began the Arts course but abandoned it after his first year, and never graduated. He was apprenticed to Alexander McKenzie Edwards, the Extramural Lecturer on Surgery, and for six years acted as his assistant after he qualified in 1866. During his student career he became a favourite with James Syme (qv) and Sir William Fergusson (qv), and for some time lived in Sir James Simpson's house.

He left Edinburgh in 1866, visited Dublin and other schools of medicine, and was appointed House Surgeon to the Wakefield Hospital in 1867, a post he held for three years, performing his first ovariotomy there on July 29th, 1868. He performed five similar operations before he removed to Birmingham in 1870, and these seem to have directed his attention specially to what became the work of his life. He took the practice of Thomas Partridge in September, 1870, and settled in Birmingham at the corner of Burbury Street, Lozells Road, where be soon made a name for himself as a bold surgeon, an original thinker, and an aggressive enemy.

He was Lecturer on Physiology at the Midland Institute from 1871-1879, where his advocacy of the Darwinian theory of evolution excited considerable opposition. In July, 1871, he was appointed Surgeon to the newly founded Hospital for Diseases of Women, and held the post until 1893, when he was elected a member of the Consulting Staff. 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.

He performed two operations of historic importance in 1872: the first on Feb 2nd, when he removed a suppurating ovary; the second on Aug 1st, 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, Koeberlé's technique, and in June, 1876, he removed a haematosalpinx and thus made the profession familiar with the pathology of the condition.

In 1878 Tait began to express doubts as to the value of the Listerian carbolic acid spray then generally employed by surgeons in abdominal operations, but adopted no aseptic method except that of general cleanliness. In 1879 he did his first cholecystotomy, an operation which marked the beginning of the rational surgery of the gall-bladder. 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.

Lawson Tait was instrumental in organizing the Birmingham Medical Institute, of which he was an original member in 1874, and was one of the founders of the British Gynaecological Society, serving as President in 1885. He became Professor of Gynaecology at Queen's College in 1887, and was appointed Bailiff of the Mason College in 1890. He was the chief mover in causing the transfer of Queen's College to the Mason College in 1892, and thus smoothed the way for the foundation of the University of Birmingham.

Tait performed many of the duties of a citizen in Birmingham. Elected a member of the City Council in 1876, as a representative of the Bordesley Division he became Chairman of the Health Committee and a member of the Asylums Committee. He contested the Bordesley Division of the City in the Gladstonian interest in 1886, but was easily beaten by Jesse Collings.

In the British Medical Association Tait was a Member of Council, President of the Birmingham Branch and of the Worcestershire and Herefordshire Branch, and delivered the Address on Surgery at the Birmingham Meeting in 1890. He was President of the Medical Defence Union and raised the Society to a position of considerable importance. In 1876 he was President of the Birmingham Natural History Society, and in 1884 President of the Birmingham Philosophical Society. He was also Professor of Anatomy at the Royal Society of Artists and Birmingham School of Design, and was a founder of the Midland Union of Natural History Societies. He took a leading part in establishing coffee-houses in Birmingham.

The University of the State of New York conferred upon him honoris causa the degree of MD in 1886, and in 1889 he received a similar tribute from the St Louis College of Physicians and Surgeons, whilst in 1888 the Union University of New York gave him the honorary degree of LLD. At the time of his death he was an Hon Fellow of the American Gynaecological Society and of the American Association of Obstetricians and Gynaecologists.

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: his body was cremated at Liverpool and the ashes were buried in Gogarth's Cave, an ancient burial-place in the grounds of his Welsh home on the west side of Great Orme's Head. He married in 1871 Sybil Anne, a daughter of William Stewart, solicitor, of Wakefield, Yorkshire, but had no children.

Alban Doran (qv), a contemporary of Tait, who was himself a distinguished gynaecologist, summed up his work in the following words:

"Tait's special merits as a surgeon cannot be lightly dismissed. He, no doubt, placed too low a value on scientific research; his statistical methods, well fitted for earlier days, when Clay, Spencer Wells, and Keith had to prove the bare justifiability of ovariotomy, were already antiquated when he so largely employed them; and he, in the opinion of many surgeons of repute, laid too little stress on after-treatment. Nevertheless, it is easy to recognize that, without doubt, he was a very great surgeon.

"Lawson Tait began, as all abdominal surgeons had to begin in the days when he entered into his professional career, by ovariotomy. He advocated a small abdominal incision, and confirmed the superiority of complete intraperitoneal ligature over the clamp. It is not necessary to dwell on his long disputes with other operators, nor on his statistics, nor on his persistent opposition to antiseptics. He relied on his good right hand, an excellent principle for any surgeon, provided that, as in the case of Tait, his right hand be really good. He, on the whole, distrusted hysterectomy, but it is in the surgery of the appendages that he gained the most renown. By this term he understood, as all have since understood, the removal of the ovary and Fallopian tube for diseases due not to new growths, but to inflammation. Though no doubt operative interference for hydrosalpinx, pyosalpinx, and chronic oöphoritis was grossly abused at first, it cannot be denied that Tait threw a bright flood of light literally and figuratively on the nature, course, and treatment of tubo-ovarian inflammation. To understand his views thoroughly it is necessary to study the clear statements which he boldly makes in his Diseases of Women and Abdominal Surgery, 1889. The very headings of the pages, 'Heavy Mortality of Pyosalpinx', 'Pyosalpinx resulting from Uterine Tinkering', etc, are characteristic and most suggestive. Thus the first heading has been gravely disputed, but Tait knew how to act as counsel for the prosecution of a suppurating tube. The second implies the most just surgical censure. We know but too well that it is not only tubes that suffer from therapeutical tinkering and timid palliative measures.

"At an early period of his career as an abdominal surgeon Lawson Tait distinguished himself by advancing, in an operative sense, beyond the limits of the female organs. He was an advocate of timely interference in disease of the gallbladder at a date when ovariotomy was hardly generalized and when hospital surgeons were as suspicious of any attempts at operation in the upper part of the abdomen as twenty years earlier they had been suspicious of ovariotomy itself. He carried his principles into practice, and so his name is chronicled in the history of our art as one of the pioneers of the surgery of the liver and gall-bladder. Just thirty years ago Lawson Tait opened up a sinus which discharged through the umbilicus and communicated with a suppurating gall-bladder, so that he was enabled to remove some gall-stones. Nine years later Dr Marion Sims boldly performed cholecystotomy on a patient whose health was already impaired by long-standing obstruction of the bile-ducts. Relief was immediate, but the patient sank a week later. For Marion Sims, Lawson Tait had the deepest admiration, and dedicated to the great American gynaecologist his Pathology and Treatment of Diseases of the Ovaries 'as an acknowledgment that much of the new work described in it was the outcome of his ingenuity'. As an outcome of Sims's ingenuity beyond the area of the uterus and its appendages, Tait successfully performed a cholecystotomy in 1879, one year after Sims's operation. A living authority on hepatic surgery, Mr Mayo Robson, justly observes that 'to Mr Tait undoubtedly belongs the credit of having popularized the operation with the profession'.

"Tait's renown and experience caused many others to bring to him patients with abdominal affections which baffled their powers of diagnosis. In 1887 he recorded a large series of operations for cystic collections of fluid in the anterior and inferior part of the abdomen. He treated them, as a rule successfully, by incision and drainage, and believed that the cysts had developed in the urachus. There is reason to suspect that some of these cases were simply encysted dropsies due to tuberculous disease, and their true pathology was in no instance verified by dissection or post-mortem examination. Still there can be little doubt that in more than one instance the tumour was urachal. What is more important, Tait established, by the publication of this series, the correct principles for the treatment of this rare disease. Hence, in the surgery of tumours of the urachus, Tait once more appears as a pioneer whose claims will not be forgotten.

"Perhaps the most original and at the same time most valuable innovation which surgery owes to Lawson Tait is the washing of the peritoneum, after an operation, with large quantities of water for the purposes of cleansing and haemostasis. Many other terms have been applied to this method, but his original contribution on this subject in the third volume of the British Gynaecological Journal [1887-8, iii, 185] is named 'Methods of Cleansing the Peritoneum', and the only other term in this remarkable essay besides 'cleansing' is 'washing'. Whatever it should strictly be called in accordance with the science of hydraulics, this cleansing of the peritoneum has proved of the greatest benefit, and, although it has been much abused and often applied when unnecessary, though harmless, it has been found by later observers to act favourably on the patient in certain ways quite unrecognized by its famous inventor. Tait avowedly claimed cleansing and haemostasis as the aim of washing of the peritoneum. Within a few years it was found that it was also a process of transfusion. Later, it was shown that when some of the water was left behind in the peritoneal cavity it ensured the rapid removal of poisonous products from the peritoneum. It has further been discovered that the addition of salt greatly increases the transfusing and antiseptic value of the water used for cleansing the peritoneum. Such remarkable development of a new surgical practice greatly redounds to the credit of its inventor. Lawson Tait was, in respect to washing of the peritoneum, once again a bold projector who successfully carried an original design into practice. He did so on the sound surgical principle that the less the surgeon fears the peritoneum and the more thoroughly he cleans it and checks bleeding and oozing, the better it will be for the patient.

"Enough has been said to show that Lawson Tait will always be remembered as a bold surgeon of unusual originality. His merits, widely recognized in his lifetime, will not be forgotten after his death, for he made a name for himself in the glorious history of British surgery."

As a man Tait was a sound antiquarian, a good raconteur, and an admirable public speaker who kept the attention of his audience. In person he was short, broad-chested, and had a very large head from which fell long hair. His face was severe and plebeian in character, but gave the impression that he had a large fund of common sense. He listened carefully to what was told him and replied in the fewest possible words, his lips hardly moving.

Publications:
The Pathology and Treatment of Diseases of the Ovaries (the Hastings Prize Essay, 1873), London, 1874; 4th ed, 1883.
An Essay on Hospital Mortality based on the Statistics of the Hospitals of Great Britain for Fifteen Years, 8vo, London, 1877.
Diseases of Women, 8vo, London, 1877; 2nd ed, 1886. It appeared in New York in 1879; in Philadelphia in 1889; and was translated into French by Dr Olivier in 1886 and by Dr Bétrix in 1891.
The Uselessness of Vivisection upon Animals as a Method of Scientific Research, 8vo, Birmingham, 1882; reissued in America in 1883, and translated into German, Dresden, 1883. It is full of fallacies.
Lectures on Ectopic Pregnancy and Pelvic Haematocele, 8vo, Birmingham, 1888.

Sources used to compile this entry: [Dict Nat Biog, Supplement iii, sub nomine et auct ibi cit. Stewart McKay's Lawson Tait, his Life and Work, London, 1922. This contains several portraits of Lawson Tait at different periods in his life. As to the vexed question of Tait's parentage, see W G Spencer in Brit Med Jour, 1922, ii, 1032; 1925, ii, 402].

The Royal College of Surgeons of England