You may like to see a speech that Mr Joe Jordan...a now retired eminent Gynaecologist from the Women's Hospital gave to the Royal College of Obstetrics and Gynaecology about Lawson Tait....
Henri De Mondeville, writing in the 14th century, listed the qualities of the ideal surgeon. He said “and I doo note four things moste specially that every Chirurgion ought to have. The first that he be learned; the second that he be expert, the thirde that he be ingenious; the fourth that he be well mannered.”
“...Father of Abdominal Surgery.”
Robert Lawson Tait was born in Edinburgh on the 1st May 1845. He was without question one of the greatest surgeons of all time and indeed sometimes is regarded as the “Father of Abdominal Surgery.” Remarkable as he was he did not fill all of De Mondeville’s criteria. He was certainly learned. He was unquestionably an expert surgeon and reference to his publications show that he was indeed ingenious. However, even those who thought most kindly of him would hardly say that he was invariably well mannered! He was educated at Heriot’s School in Edinburgh. From Heriot’s he won a scholarship to the University of Edinburgh and became a University student in 1860 at the age of 15. He enrolled as an arts student but after one year he abandoned the arts and turned to medicine. While still a student he became a pupil of Sir James Young Simpson. He lived in Simpson’s house and frequently assisted him in his private operations. Simpson had a great influence on Tait’s life and Tait always spoke very highly of him. There was a rumour that Tait was the natural but illegitimate son of J.Y. Simpson and indeed there is some similarity between the two. However, there is on record a direct denial which came from Tait himself, in which he said the story was not true and that he came of “perfectly respectable though not distinguished parents.”
“...first ovariotomy...”
Tait graduated in 1866 and spent the next 12 months visiting Dublin and other medical schools. In 1867 he was appointed resident house surgeon to the Clayton Hospital, Wakefield, where he remained for 3 years. In 1868, he performed his first ovariotomy (a term which he used to describe removal of the ovary) and before he left Wakefield in 1870 he had performed a total of 5 ovariotomies. During this 3 year period he published several articles and letters on subjects as wide ranging as cleft palate, removal of the coccyx, uterine epilepsy, in addition to which he wrote 5 articles on archaeological topics!
In 1870 Tait moved to Birmingham where he acquired the general practice and house of Dr Partridge. However, within a matter of weeks he discontinued the practice and became a consulting surgeon. To supplement his income at that time he wrote leading articles for the Birmingham Morning News.
“...hospital for women in Birmingham...”
In 1871 he became a Lecturer in Physiology and Biology at the Midland Institute and in his lectures he taught the doctrine of evolution and Darwinism. He was a staunch proponent of Darwin but his support of Darwin’s teachings raised a storm of abuse and caused him to be looked upon by many pious people as an atheist and heretic.
Also in 1871 he proposed that there should be a hospital for women in Birmingham, and supported by Mr Arthur Chamberlain, of the famous Chamberlain family, the first Birmingham and Midland Hospital for Women was founded in a rented house at No. 8 The Crescent. This was not an easy task for he was opposed by both hospitals in Birmingham, the General Hospital and the Queen’s Hospital.
Tait did not have it all his own way because the committee which formed the hospital passed a rule that acting surgeons must be a Fellow of the Royal College of Surgeons (England) whereas Tait was only a Member. Within three months he had obtained his Fellowship and he and Dr Savage, Dr Bracey and Dr Ross Jordan were appointed as surgeons to the new hospital.
“...turning point in abdominal surgery...”
In 1872 he began to remove ovaries “to arrest menstrual haemorrhage due to uterine myoma and for chronic ovaritis.” This operation came to be known in England and America as “Tait’s operation.” The following year, 1873 was an eventful year. The annual meeting of the British Medical Association was held in Birmingham. Tait was awarded the Hastings Gold Medal for his essay on “Diseases of the ovary,” and he was appointed Secretary of the Obstetrical Section of the BMA. Later in 1873 came a major advance in abdominal surgery when Tait decided to ligature the ovarian pedicle with silk, thereby leaving it intraperitoneally, as opposed to using a wooden clamp which remained extraperitoneally: this was a turning point in abdominal surgery and it was responsible for a significant reduction in mortality from the operation.
“...Essay on Hospital Mortality.”
In 1877 he published his “Essay on Hospital Mortality.” This was based on papers left to him by Sir James Y. Simpson. He had collected mortality data from various hospitals and in his essay he attacked the large hospitals (especially the General Hospital in Birmingham) emphasising the high mortality attending the operations performed there. He drew attention to a small hospital like the Women’s Hospital in Birmingham and stated that surgery should only be performed in such small hospitals. At about the same time he became aware of the problems caused by diseased Fallopian tubes and began to perform bilateral salpingectomies for acute and chronic pelvic inflammatory disease.
“...the first cholecystotomy in Europe...”
1879 was probably his most important single year. In this year he performed the first cholecystotomy in Europe, he was the first person to remove a pyosalpinx, He also used the term “exploratory incision” and in a later edition of his book “Diseases of the ovaries” he stated “I ventureto lay down a surgical law but in every case of disease in the abdomen and pelvis in which the health is destroyed or life threatened, and in which the condition is not evidently due to malignant disease, an exploration of the cavity should be made.” In other words he was advocating “exploratory or diagnostic laparotomy.”
In 1888 he published a series of 100 cases of ovariotomy in which he attacked Listerism (antisepsis). Of his first 50 cases of ovariotomy, performed with the aid of Listerism, the mortality was 38%. In the second 50, without Listerism, it was only 6%. He claimed that this improvement was due not only to his increasing skill and experience but to the adoption of simple cleanliness (asepsis) in the place of Listers antiseptic methods. We now know that the main factor in his success was the abandonment of the extraperitoneal clamp in favour of ligaturing the ovarian pedicle with silk and leaving it in the peritoneal cavity. In his attack on Listerism, Tait also criticised many surgeons as using the antiseptic spray as a “royal road to surgical success” as being the excuse for inexperienced and incompetent surgeons tackling cases that they ought to have left to more experienced and skilled colleagues. Typical Tait! It was unfortunate that he chose to attack Listerism in this way because in fact both were saying the same thing, with one advocating asepsis and the other antisepsis.
“...management of ruptured tubal pregnancy.”
Frequently Tait is remembered for his work in the management of ruptured tubal pregnancy. In 1883 he operated on his first case, a patient of Dr Spackman of Wolverhampton. Unfortunately the woman was almost dead at the time of the operation and died immediately afterwards. Two months later he operated on the second case, a patient of Dr Page of Solihull Birmingham, the patient made an excellent recovery and was the first successful case on record. During the next 5 years he operated on 40 other such cases with only one death.
Tait is often referred to as “the father of abdominal surgery” and his figures show that he was an indefatigable worker and that his results were good. However, one can assess results as being good only by audit and to Tait must also be given some credit as being one of the pioneers of medical audit, by virtue of a publication in 1884 of an analysis of his first 1,000 cases of abdominal section (described by Tait as an operation in which the peritoneum was opened.) His overall mortality was 9.3%. Tait commented that he could not state whether this was high or low because “no such series has been published and, therefore, I cannot discuss it relatively!” However, he agreed that it included all his early cases where “the want of experience told heavily.”
Also in 1884 Tait visited Canada and America and immediately following his visit Americans flocked to Birmingham: this caused so much disruption to his work that finally he refused to take and accept his pupils for except for a fee of 100 guineas each!
“...President British Gynaecological Society...”
In 1887 he was elected President of the newly formed British Gynaecological Society and in the same year stood unsuccessfully for Parliament.
funny how much we can learn if we research our own little neck of the woods...although born in scotland lawson tait practiced in birmingham all his working life saving many lives he also opened the birmingham hospital for women..on the 1871 census he was living and working at 317 burbury st with his mother...he moved a couple of times but this house is the only one still standing and still has the two pillars each side of the door as described in this newspaper article written in 1970..shame he did not get more recognition although having said that i think he may be remembered at the general hospital...will try and find out about that
....in my opinon he should be more than well deserving of a blue plaque especially as his house is still standing but as most of us know that will never happen...like i said earlier now that i know just how large the house and gardens were/are i will be taking a trip down there soon to get some photos other than st view ones..i did take some about 2 years back but i cant find them now but its not a problem to re take them...
