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This thesis will detail a brief overview of the modern history of the stomach, analysing not only the responses of the medical community to its various conditions but also the wider socio-cultural aspects of the organ's illnesses in Britain throughout the broad period 1800-1950. In doing so, I also aim to address issues relevant to peptic ulcer epidemiology, adding complexity to existing models of the 'rise and fall' of the disease during the nineteenth and early-twentieth century. The thesis begins by revealing why and how the Victorians became obsessed with matters of digestion and the manner by which the maintenance of the health of the stomach became conceptualised as holding the potential to ensure overall bodily health. I shall investigate the numerous advice manuals on the topic intended to be read by physicians, surgeons and the general public, all of which, I shall suggest, prioritised the stomach as the most important of all of the major bodily organs amidst an increasing emphasis in the medical literature upon concepts of nervousness. By doing so, I aim to explore relationships perceived as existing between the stomach, the individual and industrial, civilised British society during the nineteenth-century. I shall then contrast these representations of the stomach with those provided by emergent forms of reductionist medicine. I shall assess the centrality of the stomach within laboratory medicine, assessing the role of ethically problematic experiments undertaken on dogs and monkeys, including sham-feeding and the production of stomach ulcers via acid injections in monkeys. I then relate this to the technologies that emerged and the transference of these onto the human, a process which I suggest accumulated in the use of the stomach tube to force-feed imprisoned Suffragette campaigners during the early decades of the twentieth century. Contemporaneously, abdominal surgery also offered highly reductionist models of the stomach's bodily role, which deprioritised its importance to the maintenance of general health. Notably, turn-of-the-century surgeons regularly attempted to remove the organ in the belief that the human could live healthily completely stomachless. Yet, I argue that they also partitioned the organ by providing more precise definitions of its medical conditions in any given part of the organ, forming a sharp contrast to the arguably more vague interpretations of the organ previously on offer. This allowed for diagnostic shifts that encouraged the recognition of problems such as duodenal ulcer. The thesis concludes by analysing the phenomena of 'air-raid ulcers' and 'dyspeptic soldiers' during the Second World War, a period when alarming numbers of British people, both in military and civilian settings, began to suffer from crippling gastric complaints. In doing so, I aim to assess the revival of patient-orientated concepts that characterised nineteenth-century constructions of gastric illness, although stressing that what was now emphasised was the role of the psychosomatic rather than somatopsychic.

Despite the 'hostile' geographic and climatic conditions, millions of people live, work and reproduce at great altitudes in the mountainous regions of the Andes, the Himalayas and the Ethiopian highlands. This thesis examines medical efforts to understand the effects of altitude in health during the first half of the twentieth century. This thesis explores how physicians, clinical researchers and physiologists have approached the 'altitude problem'; who and why has worked in high-altitude medical research; and what were the contexts and consequences of the application of this research. The primary focus of this study is on the work in the Peruvian Andes, though, it is set in the context of developing international medical and research networks. By exploring the discipline of 'high-altitude medicine' this thesis illustrates the importance of 'place' in twentieth century medicine, shows the centrality of the Andean region for high-altitude medical research, the reconstruction of 'high-altitudes' as hypoxic environments and how attitudes towards 'mountain sickness' changed along the first half of the twentieth century.

<bold>Part Three</bold> examines the development of Beauchamp and Childress 'four principles' approach to medical ethics from the 1<super> st</super> to the 6<super>th</super> Editions of <italic>Principles of Biomedical Ethics,</italic> arguing that it has, thanks to changes in the authors' conception of philosophical moral theory, been able to productively incorporate the views of many of its critics over this time; that it is also able to incorporate features of different ethical approaches such as virtue ethics, narrative ethics and ethics of care; and that, properly understood, it continues to provide a good framework both for moral reflection in medicine and the provision of concrete action-guides. The thesis concludes by considering this view of the four principles in the light of the earlier sections' approach, and attempting to demonstrate further demonstrate their value through two case-studies.

This thesis explores the foundation and operation of the first hospital to be established and run by women doctors in Scotland, the Edinburgh Hospital for Women and Children (1885), and its sister Hospital, the Hospice (1899) (the Elsie Inglis Memorial Maternity Hospital). Its main concern is to consider the social and cultural factors which shaped women doctors' professional interests at these institutions. Chapter 1 outlines notions of feminine propriety which prevailed in the Victorian penod, and considers how middle-class women sought to subvert these restrictions and gain for themselves some sort of active role in public life. The foundation of the Edinburgh Hospital, and the Hospice, is considered within this context. The women who made up the Executive Committee of the Hospital are shown to have been part of a wider local and national feminist network, and this support undoubtedly contributed to the Hospitals' success. Chapter 2 looks at the significance for the medical women of the changing nature of medical knowledge in the late nineteenth century. In this period the discipline of physiology gradually shifted from a holistic conception of the body to a more organ centred, reductionist model. Women doctors argued that the older conception of physiology, which could also be understood as hygiene, was of great interest to female practitioners. Women doctors, they suggested, would be the most suitable ambassadors for the dissemination of knowledge of personal and domestic hygiene to women at large. As the dispensers of such knowledge, it was also suggested that women doctors would act as agents of morality with regard to health, cleanliness and moderation amongst this important constituency. Chapter 3 suggests that the actual practice of medicine at the Edinburgh Hospital for Women and Children reflected the same preoccupation with hygiene and the holistic conception of physiology that had been used in women's arguments to enter the medical profession in the 1870s. The theme of morality, specifically the morality implicit in the practice of medicine at the Edinburgh Hospital continues to be explored. Chapter 4 shifts the focus of attention to the recipients, rather than the providers, of medical care at the Edinburgh Hospital by considering the lower middle and working-class women who received medical treatment there. It explores the illnesses (and their causes) which these patients complained of, and explores the social role which the Hospital served in the community, from its foundation in 1885 to the end of the century. Chapter 5 is concerned with the medical women's work at the Hospice. It discusses the emergence of a distinct specialism, infant and maternal welfare, which occurred at this institution from 1905. The development of this specialism is linked to the limited opportunities which existed for medical women in the city, as well as to the moral role in medical practice which they had outlined for themselves in the previous century. Chapter 6 continues to explore these themes in relation to the development of the Edinburgh Hospital as a centre for the treatment of VD in the inter-war period. A growing pragmatism amongst the medical women is observed, and a shift in the moral tone of their work is pinpointed as they become increasingly bound up with the propaganda campaigns of the NCCVD and the Public Health Department of Edinburgh Town Council.

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Respiratory disease has affected human populations throughout our history and remains a significant cause of morbidity and mortality today. In spite of this, there is a dearth of bioarchaeological research on this important subject. Previous research has suggested a relationship between poor air quality and the prevalence of chronic maxillary sinusitis and rib periostitis. These conditions have many causes (e.g. congenital disorders, allergies, poor air quality, climate, infectious disease). Chronic maxillary sinusitis and rib periostitis are recognised as bone formation and/or destruction, indicating long-term inflammation of the soft tissues of the sinuses and ribs in some upper and lower respiratory tract conditions. If air quality is a significant contributor to respiratory disease, the highest prevalence rates would be expected in populations exposed to high concentrations of indoor and outdoor pollutants. This study examines 12 skeletal samples from cemeteries located in southern England, ranging in date from the Iron Age to the Post Medieval Period. The samples were chosen to examine both synchronic and diachronic trends in respiratory disease, contrasting contemporaneous populations living in rural and urban contexts, as well as populations from high and low social status groups. A total of 1203 individuals were examined for this study. Of these, 1101 had at least one sinus preserved, and of these individuals, 546 (49.6%) had sinusitis in one or both sinuses. A total of 2091 sinuses were recorded. Of these, 854 (40.8%) had chronic maxillary sinusitis. 50.42% of 720 males and analysed had sinusitis and 47.85% of 372 females (not significant). Prevalence rates ranged from 30.6% (Post Medieval) to 75.44% (Iron Age) for chronic maxillary sinusitis and 1.59% (Iron Age) to 29.7% (Post Medieval) for rib periostitis, but, when combining the skeletal and archaeological/historical data, the hypothesis posed is not consistently supported. Based on archaeological evidence for lifestyle and housing, these results suggest that the causes of respiratory disease are more complex than this current hypothesis presumes.

Medical diagnoses define the possible modes of being ill from the medical point of view. Medical diagnoses are theoretical concepts that gain their meaning as a part of the prevailing medical theory. As medical theories change over time, also medical concepts change, as can be seen in the long history of medical thinking. The purpose of this essay is to illustrate medical thinking through examining the formation and use of one example of a particular medical concept “psychosomatic” in medical theory and practice. The approach taken in this essay reflects the writings of Lev Vygotsky, who argued that scientific concepts are tools for scientific thinking. Since all conceptual tools have their own developmental history, to understand the content of any scientific concept to the full we need to understand the processes leading to adoption of that particular concept for scientific inquiry at that particular moment in history. Vygotsky’s approach for analysing the development of science through analysing its concepts is reflected to the writings of Kuhn and Fleck on the development of science. It is argued, that Kuhn’s theory does not apply to the development of medicine. While Fleck’s approach seems to fit better to analysing the theoretical development in medicine, it remains somewhat superficial in analysing the nature and role of concepts in medical thinking. The use of medical concepts in medical practice is discussed in the light of Mikael Leiman’s ideas on the therapeutic encounter as a dialogical process. While Leiman also draws from Vygotsky he takes the issue further toward semiotic understanding of clinical dialogue by using Bakhtin’s and Voloshinov’s ideas of the semiotic nature of human communication.

The biocultural and epidemiological approaches have been used as investigative methods by which to assess the prevalence of birth defects of the axial skeleton among five English Medieval population samples (Raunds Fumells, Northamptonshire; the hospital/almshouse of St James and St Mary Magdalene, Chichester, West Sussex; St Helen-on-the-Walls, York; Wharram Percy, East Yorkshire, and the Augustinian Friary cemetery, Hull, Humberside).The author hypothesises that Medieval urban populations produced offspring with higher frequencies of skeletal defects because they were subject to the adverse health-mediating effects of higher population density. These include poor quality, frequently overcrowded living conditions, poor sanitation, increased rates of disease threat and transmission, poorer quality food and drink due to pollution and adulteration, and greater levels of industrial-related air and water pollution. The author proposes that this response was a consequence of the impaired interaction between a population-wide compromised nutritional status and a co-existing weakened immune response. It is proposed that rural populations will express significantly lower frequencies of the same skeletal defects, as they are not subject to the same adverse environmental effects of population density and urban living conditions. The results support this hypothesis among the four populations derived from burial grounds associated with residential areas, whilst the Hull population expresses a rural pattern of defect prevalence, raising questions of possibly limited, exclusive access to burial at that site, available to non-urban dwellers. The author suggests that similar reproductive effects may be found today in populations undergoing demographic transition, for example, those experiencing the process of urbanisation in the developing world, or those migrating to the developed West. The author also shows how the results, when viewed alongside the medical literature, may indicate the presence of soft-tissue anomalies which are invisible to those working with dry bone. Keywords: urban, rural, medieval, birth defects, congenital, urbanisation, population density, biocultural, epidemiology, spine, cleft palate, skeleton, archaeology, palaeopathology.

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