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Biographical entry Ballance, Sir Charles Alfred (1856 - 1936)

KCMG 1918; CB 1916; MVO 1906; MRCS 23 July 1879; FRCS 8 June 1882; MB BS London 1881; MS 1882; Hon LLD Glasgow 1927; Hon MD Malta; Hon FACS 1928.

30 August 1856
Clapton, Middlesex
8 February 1936
ENT surgeon


Born at Clapton, Middlesex, on 30 August 1856, the second child and eldest son of the four boys and four girls born to Charles Alfred Ballance (d 1873), of Taunton, where he had been in business as a government contractor for timber, and his wife Caroline Hendebrouck Pollard. Sir Hamilton Ashley Ballance, FRCS was his youngest brother, and his youngest sister married Sir John L Myers, FBA, Fellow of New College, Oxford. After his father's death the business was sold and the family moved to Stanley House, Clapton. Charles Ballance was educated at Taunton College under the Rev William Tuckwell, and afterwards in Germany. He then entered St Thomas's Hospital where he served as house surgeon and was for a time demonstrator of anatomy. At the University of London he gained one of the gold medals at the examination for the BS in 1881, the other being won by Victor Horsley, and had similar success at the MS in 1882.

He was appointed aural surgeon to St Thomas's Hospital in April 1888. The department was then at a very low ebb of efficiency but Ballance quickly developed it on both practical and scientific lines. He went to Germany, visited nine German clinics, and was among the first to perform the radical mastoid operation with ligation of the jugular vein and drainage of the lateral sinus. He thus followed the treatment recommended by H Schwartze, by Kuster, and by L Stacke. He further improved the operation by lining the cavity in the mastoid with an epithelial graft. In December 1891 he was made assistant surgeon after a severely contested election with W H Battle, FRCS, when Battle was placed first and an additional assistant surgeoncy was made for Ballance. In December 1900 he became surgeon to the hospital and held office until April 1919 when he resigned and was appointed consulting surgeon. He was elected surgeon to the National Hospital for the Paralysed and Epileptic in Queen Square, Bloomsbury, on 17 February 1891, Victor Horsley being his surgical colleague, and resigned on 19 May 1908, when he was elected consulting surgeon.

From 1912 to 1926 he was chief surgeon to the Metropolitan Police, Clinton Dent, FRCS being his predecessor in the office. Having already accepted a commission as captain à la suite, to which he was gazetted on 23 December 1908 in the newly formed RAMC branch of the territorial force, Ballance was called up on the outbreak of war in 1915 and was then attached to the second London (City) general hospital. He was promoted temporary colonel AMS on 15 May 1915 and was ordered to proceed to the Near East. Here he was posted as consulting surgeon at Malta with Sir Charters Symonds, FRCS as his colleague. The two surgeons organized, supervised, and inspired with enthusiasm the large number of emergency hospitals required during the Gallipoli campaign. For his services he was given an honorary MD by the University of Malta, became a Knight of Grace of the Order of St John of Jerusalem, was decorated CB (military) in 1916 and was made a KCMG in 1918.

At the Royal College of Surgeons Ballance was an examiner in anatomy 1887-91 and a member of the Court of Examiners from 1900 to 1919. He served on the Council 1910-26 and was a vice-president in 1920. He was Erasmus Wilson lecturer 1888-89, when he took as his subject "The pathology of haemorrhage after ligation in continuity"; Bradshaw lecturer in 1919, "On the surgery of the heart"; Vicary lecturer in 1921 on "A glimpse of the surgery of the brain"; Lister memorial lecturer in 1933, "On nerve surgery", and on this occasion he received the Lister memorial medal for his distinguished contributions to surgical science. Finally he gave the Macewen memorial lecture at Glasgow, "On the surgery of the temporal bone". He served as president of the Medical Society of London in 1906 and was the first president of the newly founded Society of British Neurological Surgeons in 1927. He only held office for a year, but on resigning he was elected honorary president.

He married on 24 April 1883 Sophie Annie Smart, only daughter of Alfred Smart of The Priory, Blackheath. Lady Ballance died in 1928, leaving five daughters and a son. This son, Alaric Charles Ballance, MB, died 20 February 1933, a man of much promise (Lancet, 1933, 1, 552 and 612), leaving a widow, two sons and two daughters. The elder grandson was a student at St Thomas's at the time of Charles Ballance's death; the younger, who intended to take holy orders, was killed in action as a leading aircraftman RAF on 1 June 1941, aged 24. A daughter, Aline, married in 1919 the Rev F M Rolland, principal of Geelong College, Australia. Ballance died on 8 February 1936 and his remains were cremated at Golders Green crematorium.

Charles Ballance was perhaps the first English surgeon to re-introduce the Hunterian method of experiment into surgery. The pupils of Hunter were perhaps more interested in anatomy, morbid and comparative, than in the living patient. Ballance started afresh on the lines followed by John Hunter and to some extent by Charles Bell, and there can be no doubt that he was a pioneer in experimental surgery when most of his generation were engaged in extending bacteriology and developing the methods of Lister. But he founded no school, for he was not able to devote all or even the greater part of his time to the laboratory. He lived, however, to see that his example was bearing fruit when the laboratories were enlarged at the Royal College of Surgeons and the Buckston Browne Research Farm was opened at Downe.

His first piece of research work was begun in 1885 when he went to Leipzig and worked under the guidance of Birch-Hirschfeld upon the changes occurring in the coats of arteries tied without previous division. The work was continued at the Brown Institute in the Wandsworth Road, then under the control of Victor Horsley and Charles Sherrington, and was concluded in the medical school at St Thomas's Hospital with the help of Walter Edmunds. The results were published in 1886, and in book form in 1891. The value of the work was recognized at once and placed Ballance and Edmunds high amongst the surgical investigators of their time.

The parasitic theory of cancer was exercising the attention of many pathologists during the years 1888 to 1896. Ballance, in conjunction with S G Shattock, spent much time in investigating and testing the evidence, but without result. He was also occupied about the same time in the laboratory of St Thomas's Hospital with the behaviour of the cells which enable tissues to be repaired after inflammation. The results were published conjointly with Charles Sherrington in 1889. The repair of nerves began to interest him about 1903, when he united the hypoglossal and the facial nerves and in five cases joined the facial with the glossopharyngeal nerve. From 1899 to 1901 he was engaged in studying the processes of degeneration and regeneration of the peripheral nerves and in 1901 he published the results in collaboration with Sir James Purves-Stewart. The rest of his life was spent in experimenting with the anastomizing of nerves. The experiments were always tried upon animals before they were applied to human patients. He was often sorely tried and his work was hampered by the restrictions of the Vivisection Act, and during the last years of his life the work was carried out in the United States where he held a research fellowship at Columbia University. Here with his friend and co-worker, A B Duell of New York (d 1936), he was engaged on facial nerve repair by the use of grafts. In conjunction with W G Spencer, FRCS he wrote letters to The Times in 1919 and 1927 expressing his views upon the issues raised in the Dogs' Protection Act.

Ballance was a man of fine presence, somewhat above middle height, with a large and well-developed head. He moved with deliberation and spoke slowly in a very soft voice. A slight shyness made him seem austere at first but as soon as the outer husk was penetrated he appeared as a warm-hearted friend and a highly educated gentleman. He was particularly well read in the classics and in English literature. He was, too, a good linguist and could converse readily in French and in German. It is somewhat remarkable that his family history showed no trace of any scientific leaning, but all his brothers entered the medical profession. He worked slowly both in the laboratory and in the operating theatre but was endowed with extreme delicacy of touch and movement, so that the most delicate tissues were not injured by his manipulation.

The ligation of the larger arteries in their continuity, with W Edmunds. Med-chir Trans, 1886, 69, 443.
Cultivation experiments with new growths and normal tissues, with remarks on the parasitic theory of cancer, with S G Shattock. Trans path Soc Lond. 1887, 38, 412.
A note on the histology of sterile incubated cancerous and healthy tissues, with S G Shattock. Ibid. 1888, 39, 409.
A case of acromegaly, with W B Hadden. Trans clin Soc Lond. 1888, 21, 201.
On formation of scar tissue, with C S Sherrington. J Physiol. 1889, 10, 550.
Note on an experimental investigation into the pathology of cancer, with S G Shattock. Proc Roy Soc. 1890, 48, 392.
A treatise on the ligation of the great arteries in continuity with observations on…aneurism, with W Edmunds. London, 1891.
Cerebellar abscess secondary to ear disease; a case successfully treated by operation, with T D Acland. St Thos Hosp Rep. 1896, 23, 133.
On splenectomy for rupture without external wound. Practitioner, 1898, 60, 347: He describes in this paper the shifting dullness in the right flank and fixed dullness in the left which occurs in haemorrhage from the spleen. It is often spoken of as "Balance's sign".
The healing of nerves, with J Purves Stewart. London, 1901.
Some points in the surgery of the brain and its membranes. London, 1907; 2nd ed 1908.
Cerebral decompression in ordinary practice. London, 1912.
The Dog's Bill - scientific evidence - Pasteur and rabies, letters with W G Spencer in The Times, 19 April 1919, 30 March and 23 April 1927.
Surgical experiment; the value of the method; historical examples, letter with W G Spencer, Ibid. 29 April 1919.
Essays on the surgery of the temporal bone, with the assistance of C D Green; 2 vols. London, 1919.
On the surgery of the heart (the Bradshaw lecture, RCS 11 December 1919). London, 1920.
A glimpse into the history of the surgery of the brain (the Thomas Vicary lecture, RCS 8 December 1921). London, 1922.
Some results of nerve anastomosis. Brit J Surg. 1923-24, 11, 327.
Further results of nerve anastomosis, with Lionel Colledge and Lionel Bailey. Ibid. 1925-26, 13, 533.
The dawn and epic of neurology and surgery (the Macewen memorial lecture). Glasgow, 1930.
Mastoid operation, a glance into its history. Arch Otolaryng Chicago, 1932, 16, 55.
The operative treatment of facial palsy by the introduction of nerve grafts into the Fallopian canal and by other intra-temporal methods, with A B Duell. Ibid. 1932, 15, 1.
Short papers on certain associated problems which arose during the conduct of an experimental research on the surgical treatment of facial palsy, with A B Duell. London, 1932.
A note on the large pyramid cell of the facial area of the left Rolandic cortex in 14 Baboons and 4 rhesus monkeys, following certain experimental operations performed on the right facial nerve, with A B Duell. Dundee, 1933. The original drawings illustrating this paper were presented by Sir Charles Ballance to the Royal College of Surgeons in 1933; they are preserved in the library.
On nerve surgery (the Lister memorial lecture, RCS 5 April 1933). Dundee, 1933.
The conduct and fate of the peripheral segment of a divided nerve in the cervical region when united by the suture to the central segment of another divided nerve. From the Research Laboratories of the Royal College of Surgeons of England. London, 1934.

Sources used to compile this entry: [Dictionary of national biography, 1931-40; The Times, 10 February 1936, p 17c, portrait on p 16, a very poor likeness; Lancet, 1936, 1, 396, eulogy by Sir Charles Sherrington, OM; Brit med J. 1936, 1, 339, with portrait, not a good likeness; Nature 1936, 137, 350; St Thos Hosp Gaz. 1936, 35, 337, with portrait; Presse méd. 1936, 1, 517; RCS Annual Report of the Conservator of the Museum and Director of Research for the year 1935-36, p 20; R Sonnenschein, The elopment of mastoidectomy, Ann med Hist. 1936, 8, 500; information given by Miss Ballance, Sir Hamilton Ballance, FRCS, and W G Spencer, FRCS; personal knowledge].

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