Historical insights: John William Ballantyne 1861-1923

Abstract

Exactly 100 years ago, Ballantyne wrote in an article on Antenatal Therapeutics (Ballantyne, 1899) that whilst much was done for mothers and babies in labour and the puerperium, morbid states, such as sterility and miscarriage, the birth of monstrosities and stillbirths, twinning and fetal diseases received little attention. He noted alcohol, nicotine and lead, as well as syphilis and tuberculosis as major fetal hazards and advocated specific treatments for these in pregnancy in addition to rest and general hygiene and he advocated the induction of premature labour in women with previous stillbirth due to large fetal size. He predicted that ultimately antenatal therapy would depend on the development of accurate diagnostic techniques. Two years later, in 1901, he published a 'Plea for a Pro-maternity Hospital', (pro from Greek, later changed to pre-maternity), a concept of vital importance in the development of antenatal care (Ballantyne, 1901). Previously, pregnant women needing hospitalization were admitted under the care of general physicians with no particular expertise in obstetrics. Ballantyne taught that for an understanding of eclampsia, hyperemesis, pregnancy jaundice, hydramnios, mole, abortion and congenital malformations we had to study the physiology of pregnancy, changes in the blood and circulation, origins of the amniotic fluid and the nature of the placental exchanges. He made a passionate plea for a pro-maternity hospital where obstetricians could study both normal and abnormal pregnancy. With great vision, he stated that such a unit would need skilled X-ray services and an experienced physiological chemist. As result of this plea, Dr Freeland Barbour, Gynaecological Physician to the Edinburgh Royal Infirmary and President (1894/5) of the Edinburgh Obstetric Society, donated £1000 in 1901 to endow the first antenatal bed at the Royal Maternity Hospital in Edinburgh. Ballantyne was put in charge. The first patient admitted had hydramnios. Before this, obstetricians met their patients for the first time if called in by the attending midwife in case of difficult labour or obstructed delivery. Only in Paris was there a special ward at the Salpetrière for pregnant women. Pinard in 1878 had written on malpresentations and external cephalic version (Browne, 1946). The first refuge for abandoned pregnant women was opened in Paris by Mme Becquet in 1892 (Browne, 1946). Asylum and rest in late pregnancy reduced the incidence of eclampsia and afforded an opportunity for versions. The incidence of prematurity fell and babies born were 'larger and finer' than those of women who worked until delivery. In 1899, Dr Haig Ferguson opened a similar refuge, associated with the Edinburgh Royal Maternity Hospital, for unmarried pregnant women. The benefits of medical care and supervision were so great that the respectably married matrons from the Maternity Hospital soon demanded similar attention. This led to visits by midwives to expectant mothers in their homes in the later months of pregnancy. When the demand for this became too great, out-patient antenatal clinics were established. Haig Ferguson was too busy to provide such service and asked Ballantyne, by now lecturer in antenatal pathology and teratology in the University of Edinburgh, to take it over. Similar developments in Boston and Paris lead to the establishment of antenatal clinics there. Who was this remarkable man and what were his antecedents? He was born in Dalkeith in 1861. His paternal grandfather was a botanist and his father a seedsman and nursery gardener, concerned with propagation of fruit trees and hybridisation of azaleas and rhododendrons. His mother, of Dutch origin, died when he was one year old. As far as I am aware, he was an only child. He attended the George Watson school in Edinburgh where Latin and Greek were part of the general curriculum; he travelled in Holland (perhaps to visit his mother's family) and Germany from an early age and learned to speak both languages.