Lawson Tait

The Forgotten Gynaecologist

Robert Lawson Tait was born in Edinburgh, Scotland on 1 May 1845. He was educated at Heriot’s Hospital School and at the age of 15 began to study Arts at the University of Edinburgh. He subsequently changed to Medicine and qualified as LRCP (Licentiate of the Royal College of Physicians) and LRCS (Licentiate of the Royal College of Surgeons) at the age of 21.

In 1867, he was appointed as a House Surgeon in Wakefield, Yorkshire, and performed his first ovariotomy (removal of ovaries) there a year later. In 1870, aged 25, he moved to Birmingham where he was, in 1871, one 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 specialisms, and rather sad, that he and his wife had no children.

Over the next few years he performed many operations, including several ‘firsts’. These included further ovariotomies (also known as oophorectomies) – for sepsis and for menstrual problems, along with the first successful appendicectomy and cholecystectomy (removal of gall bladder). In 1873, he performed a laparotomy to remove a full-term, extra-uterine fetus and developed the technique of leaving the placenta in situ to reduce the risk of haemorrhage. In 1874, he performed an abdominal subtotal hysterectomy for fibromyoma, and in 1880 he performed the first successful hepatotomy (incision into the liver) to remove a hydatid cyst.

Robert Lawson Tait kept detailed records of his work. He described, for example, ‘Tait’s operation’ – the excision of the fallopian tubes and ovaries for inflammatory disease – and wrote about the involvement of the tubes and ovaries in pelvic inflammatory disease. Following this he described a second ‘Tait’s operation’ – the repair of the perineum by bringing together the levator muscles after reflection of the posterior vaginal wall. Repair of the rectum and anal sphincter were also explained.

In the late nineteenth century ectopic pregnancy had an extremely high mortality rate, and one of Tait’s greatest achievements was the development of laparotomy and salpingectomy (the removal of the fallopian tubes) to remedy the condition. He performed his first operation for a ruptured ectopic pregnancy in 1883. Sadly the patient died shortly afterwards, but Tait continued his pioneering work undeterred, and in over 40 subsequent cases, all but one woman survived: a major improvement in the management of this life-threatening condition.

His surgical successes were due in part to his ‘aseptic’ techniques. He did not agree with Lister’s use of carbolic acid for antisepsis and instead 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.

Over the years he published extensively. In 1885, he founded and became president of the Medical Defence Union (MDU). However, his strong and outspoken views against vivisection brought such criticism that he was forced to resign.

After 1891, there were no more ‘discoveries’ and he presented few papers. His reputation and practice declined further after two significant events – he was sued for libel, and he was accused by one of his nurses of being the father of her child. Financial loss meant that he had to sell many of his possessions. Tait died on June 13, 1899, at the early age of 54, from ‘nephritis’. Just before his death, he smoked one of his favourite cigars, realising that this would be his last. Lawson Tait was a pioneer in female pelvic surgery and, with his ‘aseptic’ techniques, reduced the mortality from gynaecological operations.