Robert Lawson Tait

Surgery of the abdomen was introduced into regular surgical practice in the last quarter of the 19th century . The advent of antisepsis and anaesthesia allowed surgeons regularly and successfully to operate on abdominal organs. The operations of ovariectomy and appendicectomy were amongst the first to be introduced and Robert Lawson Tait, a pupil of Simpson in Edinburgh, was a pioneer of both of these. He was the first to operate successfully for ruptured tubal pregnancy and almost certainly the first surgeon in the world to diagnose and remove successfully an acutely inflamed appendix. He made important contributions to the development of other operations such as ovariectomy, cholecystostomy and nephrectomy. Because of his public criticism of Lister and antiseptic surgery, his championing of the anti-vivisection movement and his death at a relatively early age he did not receive the honours which he deserved.

Robert Lawson Tait was born in Edinburgh and educated at George Heriot’s School and the Edinburgh Medical Faculty before continuing his education in the Extramural school of medicine. As a student he came to work closely with James Young Simpson, the Professor of Midwifery. Simpson was to promote Tait’s early career, and later they were to became friends. Tait remained an admirer and disciple of Simpson throughout his life. After graduation Tait became House Surgeon in Wakefield in Yorkshire, where he was able to put into practice the training he had received in the use of Chloroform by Simpson and in surgical techniques by Syme.He was elected FRCSEd in 1870.

Yet in his growing surgical practice in Wakefield he rejected the principles of antisepsis which had recently been published by Lister. Moving to Birmingham he became surgeon to the Birmingham and Midlands Hospital for Women and surgeon for the diseases of women to the West Bromwich Hospital. He made his mark as a bold surgeon, an aggressive debater in the British Medical Association and a prolific writer many of his letters being openly critical of other surgeons.

He took up the operation of ovariectomy which had been developed by Spencer Wells in London and by Thomas Keith in Edinburgh (qv). Tait’s contribution was to introduce the method of simple ligation of the pedicle. He went on to make an even more original contribution in the diagnosis and management of ectopic pregnancy. By describing the diagnostic features, advocating the need for early operation and the use of appropriate ligation, he ensured the safe introduction of this procedure into surgical practice.

Despite his appointment to a hospital for women he made important advances in abdominal surgery. W. J. Mayo was to write “the cavities of the body were a sealed book until the father of modern abdominal surgery, Lawson Tait, carried the sense of sight into the abdomen”. Although not the first to perform cholecystostomy he was the first surgeon to perform this successfully in Britain. His contribution to the understanding and treatment of acute appendicitis was arguably even greater. In 1880 he made the diagnosis of peritonitis due to rupture of the appendix and successfully removed a gangrenous appendix. He went on to advocate exploratory laparotomy for abdominal pain, a radical proposal at the time and one which resulted in enemies among the advocates of a conservative approach. Tait made further enemies by his vehement criticism of Lister and Listerian antisepsis. He also espoused two unpopular causes which were to become much more popular with the passage of time. Firstly he became a disciple of Charles Darwin. In lengthy correspondence he showed both his appreciation of the theory of evolution and made contributions to the detail from his knowledge of human anatomy. His friendship with Darwin and the lectures which he gave on evolution to local and national audiences inevitably won him enemies. He was also a prominent anti-vivisectionist which resulted in some bitter quarrels with influential doctors.

When a much publicised litigation case was brought against him by a General Practitioner and the threat of an action over his alleged seduction of a nurse, his reputation was tarnished. At the age of 48 he resigned as surgeon to the Women’s Hospital, his private practice declined, his writings diminished and he died at the age of 54.