The thesis shows that a decisive factor in the nature of Bradford's medical provision was the lack of established wealthy middle and upper classes, and the predominance of the working class in the town. Charitable institutions were set up comparatively late, and were financially unstable because of their dependence on middle class support, which was in turn largely dependent on the fluctuating worsted industry. Similarly the services provided by the Poor Law were restricted by their reliance on the rates paid by many small businesses and tradespeople whose income was affected by the condition of the town's staple industry. The working class, whose rn-health was exacerbated by the environmental conditions of a fast growing urban community, could not rely upon the inadequate charitable institutions. The poverty of the population, unable to pay for regular treatment, also contributed to a low ratio of medical practitioners. It enhanced the market for many irregular forms of treatment, a diversity which existed prior to the nineteenth century, and which continued into the twentieth century. The concluding chapters study five diseases present in Bradford during the nineteenth century, anthrax, cholera, scarlet fever, smallpox and tuberculosis, illustrating the contrasting approaches to the treatment of these particular diseases, and showing the inter-relationships between the people of Bradford and the various aspects of medical provision throughout the period.

This thesis addresses how and when British pharmaceutical firms first manufactured synthetic drugs, and how they persuaded doctors to test novel therapies in clinical trials. Edwardian Britain was reliant on Germany for synthetic drugs, so how did British firms meet this challenge in the First World War, and how was this new form of the British pharmaceutical industry nurtured in the interwar period? Previous studies have covered the industry's origins in pharmacy roots and dyestuffs, and the growth of the American indUStry, but without an overall synthesis. There are several good company histories for Britain, and Robson and Quirke compared pharmaceuticals in France and Britain, whilst Tansey examined physiological research at Burroughs Wellcome; but little has appeared on chemical research and synthetic manufacture. I will emphasise the work of Francis Carr who developed synthetic drugs at Burroughs Wellcome, Boots and British Drug Houses. As for testing, the literature covers early statistics and the clinical trials of major biological drugs such as insulin; but these did not originate with industry. With synthetic and other novel drugs, as I show, firms found it difficult to arrange clinical trials and they turned to the MRC for assistance. I examine these negotiations and trials in some detail. 9 Chapter 1 reviews the historiography ofthe pharmaceutical industry and the clinical testing of drugs. Chapter 2 examines the varied origins of the industry, contrasting ethical and patent medicines, and comparing Britain with Germany and America. Chapter 3 shows how Burroughs Wellcome combined novel drugs in sophisticated dosage forms, adopting new sales strategies and establishing laboratories to standardise drugs. Their experience in small scale synthesis from 1896 enabled them to prepare German drugs when patents were abrogated in the First World War (chapter 4). The MRC and other firms poached Burroughs Well come researchers, and the MRC took standardisation as a central theme, so establishing an international reputation. Chapter 5 addresses the postwar campaigns for tariff protection, and the extension ofMRC drug evaluations as British firms strove to remain competitive. Novel vitamin and hormonal drugs allowed them to expand their manufacturing capacity while gaining further experience of drug synthesis. Chapter 6 describes how British firms campaigned for clinical testing of drugs from 1922 -1930 and explains why a Therapeutic Trials Committee (TTC) was established in 1931. Chapter 7 examines the strategy of Burroughs Wellcome post-war, by analysing the strategic debates within their Scientific and Technical Committee. Chapter 8 examines the TTC, how they favoured British drugs, and how studies complemented their own research interests; it provides insight into the research strategies of British (and foreign) firms, plus an assessment of the TTC as seen by the MRC and by companies. Chapter 9 offers general conclusions and contrasts the position of British manufacturers at the outbreak of the Second World War with their position at the outbreak of the Great War in August 1914. Some opportunities for further work are then identified.

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This study of Fulbourn Hospital uses oral history and documentary sources to explore the models of mental illness and the therapeutic practices associated with them in one provincial English psychiatric hospital during the second half of the twentieth century. The appointment in 1953 of a new Medical Superintendent from the Maudsley Hospital, Dr David Clark, set in train a process of change which transformed the hospital through the implementation of a social model of psychiatry. This period was ended by the appointment of the leading biological psychiatrist, Professor Sir Martin Roth, as the University of Cambridge’s first Professor of Psychiatry in 1976. The subsequent years saw the appointment of psychiatrists who shared support for a medical model of psychiatry. Attention then turned to the development of care in the community through the establishment of group homes and community mental health teams. The implementation of sectorisation proved to be controversial, as did the increasing role afforded to general managers. It is concluded that many of the elements of the social model introduced by Dr Clark became absorbed into the working practices of the nursing staff, after they had been abandoned by the psychiatrists working in the hospital. This study therefore illustrates the process through which professional boundaries shifted in response to changing models of practice.

The provision of contraceptive services has been identified as one of the most important developments in primary care. Although the history ofthe birth control movement is well documented, the contribution made to the provision ofservices by nurses and midwives and the actual development oftheir role, is conspicuous by its absence. Similarly, the history ofnursing has tended to ignore the work ofthose at the 'sharp' end ofpractice. This thesis addresses both lacunae by investigating the work of the J • ~ • midwife-nurses in the Marie StopeS' Mothers' Clinics; focusing on the London and the Caravan Clinics between 1921 and 1931. The aims 0 f the study were; to trace the historical development of birth control nursing within the Marie Stopes Mothers' Clinic locating it in its social, political, medical, professional and legal.contexts; to determine the lay and medical perspectives which influenced the development ofbirth control nursing within the Marie Stopes Mothers' Clinics. This historical study uses primary archival and secondary sources supplementedby a modified prosopographical technique and oral history interviews, to provide a distinctive record of the role undertaken by the midwife-nurses in the first birth control clinic in Britain. The role ofthe midwife-nurses was unique, providing what was arguably the first nurseled birth control service in this country. In exploring the expansion ofthe service, the thesis exposes previously unexplored links between Lamberts, a commercial organisation, Abertillery Hospital and the Stopes' clinics. An exploration of the planning and development of the Caravan Clinics uncovers the way in which the service operated and the difficult conditions experienced by the midwife-nurses. Three issues of relevance to the history of nursing and contemporary practice are also revealed; the way in which the role was established: how the training for nurses working in the field of contraception and sexual health evolved; and the identification ofthe roots ofsexual health outreach services. The consequences of a disagreement between Stopes and the National Birth Control Council (NBCC) produced two distinct approaches to the delivery of care and the role of the staff. The traditional handmaiden approach continued in dinics under the auspices ofthe NBCC. The use of the speculum acted as a means to maintain the dominance of the medical profession, a situation that continued well into the 1990s. The thesis argues that had Stopes and her organisation remained within the amalgamated organisation, she may have inculcated her nurse-led approach into the work of these other clinics, with a subsequent impact on the role and training of nurses and midwives throughout the ensuing decades. Studying this group of midwife-nurses provides insight into the realities of clinical practice within what was, at the time, a controversial area ofpractice. The study has contributed to a wider appreciation of the history of both nursing and birth control while also revealing the links to contemporary clinical practice in the field of sexual health.

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This thesis aims to improve our understanding of sleep and dreams in ancient medicine, and allot dreams their own place among ancient diagnostic and prognostic procedures. First, a systematic overview of Hippocratic and Galenic diagnostic and prognostic procedures is provided. As yet, no such overview is available for the Hippocratic Corpus. To form a diagnosis or prognosis, the Hippocratics and Galen apply observation and semiotic inference, combining universal, external information concerning matters like the weather and the environment, with individual information such as a patient's symptoms and regimen and, occasionally, his dreams. Secondly, the (physiological) processes, which, according to the Hippocratics, Galen and Aristotle pertain to sleep and waking, are described in detail. A systematic account of Galen's theory of sleep is offered here for the first time. In Galen and Aristotle's accounts especially, digestion takes a central position. In all three approaches, the primary qualities - hot, cold, wet, and dry - play an important role. Lastly, the discussion of the Hippocratic and Galenic approaches to dreams is taken beyond the standard treatises, and Aristotle's views are also examined in detail. The various Hippocratic ideas on dreams show much greater consistency than has previously been suggested. In a broad spectrum of views, On Regimen most strongly emphasises the role of dreams as significant indicators of the dreamer's physical condition. Galen, elaborating Hippocratic ideas, prominently includes factors outside of the dream in the medical interpretation of dreams. Aristotle offers the most fully fledged physiological account of the occurrence of dreams. As in On Regimen, he provides a theoretical basis for the use of dreams as a source of information about the condition of the body. This thesis shows that sleep and dreams were duly considered in ancient medical thought.

The goal of this dissertation is to investigate ancient medical concepts of phrenitis, a disease associated with high fevers and loss of reason. In particular, my dissertation examines the concepts of, and treatments for phrenitis that were put forth by the Pneumatist Aretaeus of Cappadocia (1st century AD), Galen (2nd century AD), and the Methodist Caelius Aurelianus (5th century AD). These physicians are relatively contemporary in their opinions (insofar as Caelius represents the opinions of the 1 st/2nd century AD Methodist author Soranus), and represent three different theoretical frameworks and approaches to disease. In order to provide a relevant background to the opinions of these physicians, this dissertation includes a review of concepts of phrenitis presented in a number of earlier works, including the Hippocratic Corpus, and the extant fragments of the 4th century Be physicians Diocles and Praxagoras. Together, these works constituted a tradition with which Aretaeus and Galen closely associated themselves, and against which Caelius aggressively polemicised.