A review of Teratology and the Clinic: Monsters, Obstetrics, and the Making of Antenatal Life in Edinburgh, c.1900, by Salim Al-Gailani.
Salim Al-Gailani’s dissertation explores the career and impact of the obstetrician William Ballantyne, who in the turn of the twentieth century Edinburgh transformed teratology (study of embryonic and fetal malformations) from a practice of collecting ‘monsters’ and turning them into museum specimens into a clinical discipline of ‘antenatal pathology’. This dissertation is much more than an intellectual biography: through the story of Ballantyne’s disciplinary, technical and literary innovations; his networks, audiences, practices and arguments, Al-Gailani engages with many themes of high interest to history of science and medicine. One is the history of ‘monsters’, or malformed fetal bodies. Historians have shown how the ‘freak’ was converted into a scientific specimen. Yet as Al-Gailani rightly notes (p. 7), disciplinary differences in the ways in which ‘monsters’ were treated have been overlooked or exaggerated (p. 244). Within the history of anatomy, Al-Gailani’s examination of how ‘frozen anatomy’, a sectional and representational technique, was imported, adapted to local circumstances and then used to create and support new arguments and practices around the study of the malformed feti is very useful (pp. 71–94). Much of the recent scholarship on the nineteenth-century anatomy studies the social, cultural and legal issues surrounding dissectible bodies (see for instance the work of Ruth Richardson, Michael Sappol, Elizabeth Hurren and Helen Macdonald) and their uses in medical education and practice, yet dissection practices are often regarded as monolithic. So an attempt to look closely at an anatomical method as a competing way of analyzing and viewing the body is both unusual and illuminating.
With respect to the history of childbirth and obstetrics, we know relatively much about the early era, the first inroads of men into this traditionally female field (starting with the pioneering work of Adrian Wilson) and of obstetrics into medicine but less about the twentieth century when obstetrics became an established medical specialty. And yet, as Al-Gailani shows in this dissertation, it was in this period that the remit of obstetrics changed, when obstetricians expanded their view from the mother and the delivery to pregnancy and to the fetus; indeed this is the first time that they came to position themselves as fetal advocates. Of course, Ballantyne was in many ways exceptional. But as Sara Dubow recently showed in her Ourselves Unborn: A History of the Fetus in Modern America (2011), using entirely different material, it was precisely in this period that the fetus came to be seen as an independent being rather than an extension of the maternal body. Ballantyne’s career thus may be viewed in the context of a broader shift in the understanding of pregnancy and the fetus, a shift that may be seen to herald late twentieth-century controversies around maternal and fetal bodies (see for instance the scholarship of Rosalind Pollack Petchesky and Barbara Duden). This brings me to the consideration of antenatal pathology in the context of early twentieth-century preoccupations with heredity and (declining) health of the population. It may come as a surprise that antenatal care entered medicine in the era of eugenics, but Al-Gailani highlights how medical profession overall refused to accept the sharp delineation between heredity and environment. It was the critical stance towards eugenics and belief in the malleable development that allowed viewing the antenatal period as open to intervention. So looking at antenatal care throws new light on the histories of reproduction, heredity, and child health in this period. I should point out that this does not exhaust the list of themes discussed in this rich dissertation: there is much on the relationship between science and the clinic; religion (especially evangelism) and medicine; status of patient testimony, etc.
The dissertation opens with a discussion of how the medical traditions of Edinburgh created a fertile ground for the meeting of obstetrics and teratology (Chapter 1). Ballantyne’s early career and entry into local medical culture and in particular the circle bound by the allegiance to the Free Church of Scotland are examined in the Chapter 2. In contrast to his peers, from early on Ballantyne focused on the fetus rather than the uterus. Frozen-section anatomy, a method originating in Leipzig, provided Ballantyne with a research and representational method but also with a sense of vocation that tied together clinical and scientific identity. Chapter 3 examines Ballantyne’s disciplinary innovations, or methods he used to reinvent teratology as antenatal pathology. A serious study of monsters was seen as provenance of anatomists, while obstetricians’ attempts were dismissed as light-weight anecdotes. Ballantyne criticized the anatomical-pathological museum-oriented approach and ingeniously framed the collection of clinical cases as an essential component of teratology thus privileging obstetricians’ contributions. He gave new life to the doctrine of maternal imagination in order to elevate the status of the maternal knowledge and of the obstetrician with its privileged access. Chapter 4 looks at the making of Ballantyne’s key publication, Manual of Antenatal Pathology and Hygiene. It explores Ballantyne’s experimenting with genres, as Manual succeeded less successful Diseases and deformities and the failed journal Teratologia; building supply networks, locally and outside Edinburgh and systematizing the cases. Chapter 5 examines the varied reception and uses of the Manual, and the gradual transformation of teratology into a wider mission to advance the interests of the unborn child. By the turn of the twentieth century Ballantyne’s audiences were no longer restricted to obstetricians, anatomists and pathologists but included advocates for child health working on reducing infant mortality. Finally Chapter 6 looks at the relationship between antenatal care, evangelicalism and eugenics, showing how first prematernity institution that were neither shelters for unwed mothers nor training stations for female practitioners could come into being in the era of ‘hard heredity’. It ends with a helpful if brief consideration of Ballantyne’s legacy.
In conclusion, this is an excellent dissertation that engages with themes of high interest not just in history of science and medicine but in society more broadly, so it deserves an audience well beyond historians.
University of Auckland
Edinburgh City Archives, Public Health Department
Lothian Health Services Archive: Edinburgh Hospital for Women and Children, Edinburgh Royal Maternity Hospital, Edinburgh Lying-In institution, Edinburgh Pathological Club
Midlothian Council Local Studies Centre, Ballantyne of Dalkeith Letters
National Archives: Medical Research Council Child Life Investigation Files
National Archives of Scotland: Free St. George’s Church Edinburgh
National Library of Scotland
Libraries of Royal Colleges of Physicians (London and Edinburgh)
University of Cambridge. 2011. 304 pp. Primary advisor: Nick Hopwood.