Robert Lawson Tait (1845–1899)

Robert Lawson Tait was a physician who practiced abdominal surgery in the United Kingdom during the late nineteenth century. Physicians and historians credit Tait with introducing a number of gynecologic surgeries, or surgeries related to women’s reproductive health. Those included procedures for treating abscesses, removing ovaries, and fallopian tubes, and treatment of the gallbladder. Beyond his work as a surgeon, Tait advocated against vivisection, which is the practice of medical experimentation on living animals. Tait also argued for strict cleanliness during surgery as well as a more specific focus on performing surgeries to treat diseases of the female reproductive system. Tait’s surgical techniques and advocacy not only aided in the development of hygiene in surgery, increasing patient survival, but also helped develop the field of gynecology, which contributed to a centralized focus on the health of the female reproductive system.

1. Early Life and Education
2. Professional Career
3. Anti-vivisection Advocacy and Other Controversies
4. Legacy and Impact

Early Life and Education

Tait was likely born 1 May 1845 to Isabella Stewart Lawson and Archibald Campbell Tait in Edinburgh, Scotland, though, according to Isaac Harvey Flack, a surgeon and a medical historian, Tait’s birth record may not be reliable because citizens of Scotland were not required to register births until 1855. Tait’s father worked as a judicial officer in Edinburgh. Tait’s father had a cousin, also named Archibald Campbell Tait, who was the first person from Scotland to serve as the Archbishop of Canterbury, one of the highest positions of authority in the Church of England. Researchers such as Flack, and William John Stewart McKay, an author who wrote a biography about Tait and was one of his students, report a rumor that James Young Simpson may have been Tait’s biological father. Simpson was one of the first physicians to use chloroform as an anesthetic and later became one of Tait’s academic mentors. Flack further reports that Tait himself may have helped spread the rumor about Simpson being his biological father and claims that he enjoyed the idea of having such a relationship with his teacher. However, Flack concedes that there was no evidence to confirm that rumor.

In 1852, Tait was accepted to Heriot’s Hospital, a private school in Edinburgh, Scotland, which as of 2024, is called George Heriot’s School. In 1860, he won a scholarship to the University of Edinburgh, in the same city. At the University of Edinburgh, he spent a year studying the arts before transferring to medicine. However, in 1862, Tait transferred to the Edinburgh Extramural School of Medicine in the same city. At that time, he started studying under, shadowing, and assisting Simpson and other prominent surgeons in the Edinburgh area. For example, during that time, Tait assisted Simpson in a surgery that required removing the coccyx bones, also called the tail bone, due to a condition that causes pain in that region. By 1866, Tait received licenses from the Royal College of Surgeons and the Royal College of Physicians, which are professional licensing organizations for surgeons and physicians respectively.

Professional Career

After receiving his medical licenses, in 1867, Tait began his career as a surgeon in Wakefield, England. That year, according to Flack, he began working at the Wakefield General Dispensary as the house surgeon. The Wakefield General Dispensary contained both a hospital and a dispensary, which is a place that has staff who dispenses medicines, and provides medical treatments, or medical advice. In that position, Tait was responsible for providing surgical care to the patients staying in the twelve-bed hospital. He also provided outpatient care to people in the community, often visiting patients in their own homes to treat them.

On 29 July 1868, Tait performed his first ovariotomy, during which the patient died, pushing him to work to improve the procedure. An ovariotomy, sometimes called an oophorectomy as of 2024, is a surgical procedure that involves removing one or both ovaries from a patient. Ovaries are organs in the abdomen that release egg cells in the female reproductive system. Surgeons typically perform ovariotomies to treat conditions such as infections, cysts, or cancer of the ovaries. During his time in Edinburgh, Tait had witnessed thirty ovariotomies, all of which resulted in no recovery. Despite that, Tait took on his first ovariotomy, and the patient who underwent the surgery died after the procedure due to an infection. Afterwards, Tait worked to improve the procedure and make it less dangerous. 

Along with his work improving ovariotomies, Tait spent the early 1870s as both a surgeon and an advocate for women’s health, pushing for the establishment of a women’s health hospital. In 1870, Tait started running another physician’s medical practice in Birmingham, England, and continued working as a surgeon there. The following year, he left that practice and began working as a consulting surgeon independent of a hospital placement or a general practice. In the same year, Tait got married to Silbil Stewart, whom he had met during his time in Wakefield. At that point, Tait also began advocating for the creation of a hospital for women’s health, which were uncommon in the UK at the time. By 1871, the Birmingham and Midland Hospital for Women was established, and Tait found a position within the hospital. As of 2024, the hospital still exists as the Birmingham Women’s Hospital. By 1872, Tait had completed nine ovariotomies. Other than his first attempt at the procedure in 1868, every one of his patients had survived. That made for a better record than most surgeons before him, which researchers like Flack attribute to Tait’s strict standards of cleanliness for his procedures.

During the rest of the 1870s, Tait continued working as a surgeon in Birmingham, treating patients with diseased ovaries and conducting other surgeries on the female reproductive system. One of the surgeries Tait performed was a hysterectomy, or the removal of a woman’s uterus. The first attempts at a hysterectomy began prior to the 1850s. However, it was not until 1853 when Ellis Burnham, a physician from the US, successfully conducted the first abdominal hysterectomy that did not result in the patient’s death. In the 1800s, physicians attempted to improve the surgery, but the mortality rate for a hysterectomy was as high as seventy-five percent during that time. Despite that, in January of 1874, Tait performed his first hysterectomy, to remove an eleven-pound tumor from a patient, and the patient fully recovered afterward. Around the same time, Tait performed his fiftieth ovariotomy, reporting nineteen patient deaths. It was also around that time that physicians and researchers denied the possibility of treating diseased appendages, such as the fallopian tubes, which are two small channels that connect the ovaries to the uterus. However, in 1877, Tait was one of the first to treat the diseased fallopian tubes with a salpingectomy, which is the removal of one or both fallopian tubes through surgery. According to McKay, Tait’s most notable achievement was his surgical treatment of diseased fallopian tubes.

Then, in 1879, Tait performed surgeries to treat conditions of the abdomen, such as abscesses, and to treat the gallbladder. In February 1879, he performed one of the first reported abdominal surgeries to treat a pelvic abscess. An abscess is an inflamed or swollen mass on or in the body that typically contains pus, usually due to an infection. Before Tait’s attempt at surgery, physicians typically tried to treat pelvic abscesses by using douches to rinse the area and simply instructing patients to rest. Other attempts involved draining the abscess from the vagina or from the abdomen. Tait’s method, according to Flack, involved making incisions into the abdomen to access the abscess from above before draining it using a glass drainage tube. The patients whose abscesses he treated in that manner recovered, leading Tait to continue using surgical approaches to treat issues of internal abdominal health. Later the same year, in August 1879, Tait performed his first cholecystostomy, which is the drainage or removal of hardened bile, or a gallstone, from an organ called the gallbladder. Flack reports Tait’s first cholecystostomy as the first successful one in the UK and only the second successful one in the world.

In multiple publications throughout the late 1800s, Tait criticized the emerging tradition of antisepsis in surgery and argued for what he called asepsis. Antisepsis was a set of techniques that focused on killing germs through chemicals, initially a chemical called carbolic acid, to avoid infection. In the late 1860s, Joseph Lister, a surgeon in the UK, was one of the first to experiment with antisepsis. In the case of Lister, his techniques centered on destroying the germs with chemicals, rather than keeping the ward itself clean. In multiple publications throughout the late 1800s, Tait criticized those methods and argued for what he called asepsis. Asepsis involves using water and soap to wash hands before surgery, meticulously cleaning the instruments and ward, and cleaning the patient before surgery. Tait preferred to wash his hands and most of his instruments and tools with primarily hot water and soap. Regardless of Tait’s rejection of antisepsis, his attention to cleanliness allowed him to perform surgeries with lower rates of infection and death than others of his time. According to Iain Macintyre and Sean Hughes, physicians and researchers from the UK, some researchers regard Tait's work as the basis for the aseptic techniques that physicians use in 2024.

In the early 1880s, Tait began treating ruptured ectopic pregnancies, and by 1883, Tait was one of the first to successfully treat the rupture of the ectopic pregnancy. An ectopic pregnancy is a pregnancy occurring in a part of the reproductive system other than inside the uterus. Ectopic pregnancies often occur in the fallopian tubes and cannot expand with a growing embryo like the uterus can. Untreated ectopic pregnancies often lead to rupture of the fallopian tubes, excessive internal bleeding, infection, and death. Tait reported that, in the summer of 1881, one of his colleagues asked for his help with a patient. The colleague believed the patient was suffering from internal bleeding due to a ruptured ectopic pregnancy. The colleague suggested that Tait operate on the patient to remove the ruptured fallopian tube, but Tait refused to do so. The patient died, and Tait reported that an examination of the patient’s body revealed that his colleague had correctly diagnosed the problem. Flack reports that after the examination of the patient, Tait said he believed he could have saved the patient’s life had he gone along with his colleague’s suggestion for surgery. On 17 January 1883, Tait operated on a patient also experiencing a ruptured ectopic pregnancy. Tait chose to remove the ruptured fallopian tube but took too long to stop the bleeding, causing the patient’s death after the procedure. Despite that failure, Tait operated on another patient with the same issue a few months later, and the patient survived. Flack claims that the patient was one of the first women ever to survive a ruptured ectopic pregnancy.

Anti-vivisection Advocacy and Other Controversies

The late 1880s also saw Tait engaging in the politics of medicine in the UK, which placed him in the midst of several controversies, such as his stance on vivisection, or animal experimentation, and his involvement in medical organizations. In 1882, he published a paper titled “The Uselessness of Experiments on Animals as an Instrument in Scientific Research,” attacking the practice of vivisection, which was a standard teaching practice for surgeons and medical students of the time. He stated that advancements in drug testing and surgery were not made through vivisection. In criticizing vivisection, Tait showed opposition to the broader medical establishment in the UK. According to McKay, in 1888, Tait became the president of the recently formed Birmingham branch of the Medical Defense Union, or MDU. As of 2024, the MDU still functions as a not-for-profit organization in the UK that provides physicians with legal assistance and advice in the event of patients or others suing them. In 1889, Tait became embroiled in a controversy regarding breaking a bylaw of the Association of Members of the Royal College of Surgeons. Tait sought the support of the MDU in fighting the Royal College, but many MDU members disagreed with involving their organization’s funds in the internal politics of another organization.

Tait’s career began to decline in the late 1880s and early 1890s as he became involved in a series of additional controversies and lawsuits. After a failed attempt in 1887 at running for Parliament, the supreme legislative body of the UK, he remained in Birmingham and, according to Flack, became the first professor of gynecology at Queen’s College in 1888. Despite the honor, Tait’s career began to suffer in 1892 when he wrote to a patient’s husband, criticizing his colleague who had treated the patient. The other physician found out about the communication and sued Tait for libel, which is a printed attack on a person’s character damaging their reputation. Tait received monetary support from the MDU for the libel lawsuit. However, Tait argued with the MDU about paying the MDU back for their support during the lawsuit. As a result, Tait resigned from his position as president of the organization. Following the lawsuit and his resignation, a nurse who had formerly worked with Tait alleged that he was the father of her child. Flack reports that there was no concrete evidence that Tait fathered the nurse’s child but that many of Tait’s colleagues, even those who were close to him, believed the allegations. According to Flack, the costs of Tait’s legal troubles, the damage to his professional reputation from the nurse’s allegations, and Tait’s personal spending led him into financial difficulties. By 1893, Tait had begun to suffer from kidney disease. Combined with the damage to his career, Tait’s health prevented him from working as much as he had in the past. Despite ill health, Tait continued writing papers for publication in medical journals throughout the 1890s.

Legacy and Impact

During Tait’s thirty-two-year career, he introduced a variety of surgical techniques and argued for novel approaches to surgical care. Historian John Shepherd reports that Tait wrote 328 items for publication, including journal articles and books. In addition to those publications, Shepherd writes of 270 separate letters Tait wrote to various medical journals, expressing his opinions on various medical and ethical issues as well as observations of surgical cases. In another biography, a student of Tait’s named William John Stewart McKay quotes multiple figures in medicine applauding Tait. In one such quotation from 1914, William James Mayo, one of the founders of the Mayo Clinic, a medical group that runs academic institutions and hospitals in the US, refers to Tait as the father of modern abdominal surgery. Despite controversies within his career and his incomplete understanding of bacterial infection, Tait developed surgical approaches to caring for the female reproductive system that decreased mortality in cases of disease and pregnancy complications.

Tait died on 13 June 1899 in Llandudno, Wales, at age fifty-four due to kidney disease.