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Such is the powerful, emotive nature of the subject of euthanasia that its reach stretches beyond the pages of specialised medical journals or the conference rooms of an interested few. Despite this, investigation into the historical origins of current euthanasia debates has, until very recently, been a neglected area of academic interest. Contemporary euthanasia debates are often presented in a manner where the values at stake are viewed as essentially ahistorical and my thesis seeks to address this imbalance. Beginning in the late nineteenth century and continuing throughout the twentieth century, the medical profession and lay writers in Britain mobilised an array of philosophical and technical arguments in order either to support or oppose euthanasia. My thesis elucidates and explores these arguments, tracing them through two centuries of changing attitudes towards death, suffering and pain. The thesis starts by examining how powerful pain-relieving drugs that rendered the patient unconscious were adopted into the repertoire of nineteenth-century medical practice. Then, with the position of this new form of pain relief consolidated, the first lay demands for euthanasia surfaced in the form of proposals that the incurable, suffering patient be made irrevocably unconscious so as to secure a medically-managed, painless death. Moving into the twentieth century, the official line of the medical profession was one that defended the use of pain relief that potentially shortened life but contested any suggestion that death be brought about at the patient's request. However, by the middle of the twentieth century, support for legalised euthanasia was more sustained and organised. The question of pain - whether it could be relieved and how it was to be managed - was now entrenched in the debate over euthanasia. It was in this context that the hospice movement emerged, where sophisticated pain-relieving technologies were harnessed with a distinct ideology that rejected legalised euthanasia. As I explore at the end of my thesis, this provided an institutional 'solution' to the problem of how to care for the dying patient in pain as well as a template for an 'ideal' form of death that stood as an alternative to legalised euthanasia. Informed by the methodological approaches of history and sociology, my analysis incorporates close readings of unpublished archive literature, set alongside wider surveys of pertinent primary and secondary sources. I focus on the process of how the values and ideas connected with arguments over euthanasia were articulated, placing particular emphasis on the way in which the negotiation and interpretation of medical practice fed into debates about the management of death. Throughout the thesis, I examine how the concept of 'natural' death was mobilised in a variety of ways, serving as part of the rhetorical strategies used by those on both sides of the debate. I conclude that the medical profession's commitment to the Hippocratic principle, that the physician should not kill, involved the accommodation of medical interventions in order to relieve pain in the dying patient. At the same time, however, this tended to exclude any notion that such interventions disrupted the concept of 'natural' death. This negotiation between principle and practice, I contend, is central to understanding historical arguments over euthanasia and, indeed, remains an ongoing process underpinning the construction of current debates.

This thesis has set out to investigate whether Wnt pathway components are expressed in human chondrocyte cell lines and to explore whether the Wnt pathway is involved in mechanotransduction in chondrocytes. For the first time it is demonstrated that the Wnt signalling components, Wnt-1, Fz-2, Fzrp and β catenin are expressed in human chondocyte cell lines. Fibronectin and CD44 are identified in association with chondrocyte Wnt-Fz complexes suggesting that they may be coreceptors necessary for transducing Wnt signals intracellularly. The formation of GSK3β/β catenin degradation complexes was induced by a Wnt agonist and delayed by mechanical stimulation of chondrocytes, while, induction of GSK3β activity by mechanical stimulation was inhibited by a PI3K inhibitor. These experiments suggest that the Wnt signalling pathway may be involved in mechanical signalling in these cells. However, the induction of the GSK3β activity following mechanical stimulation is mediated by a PI3K dependent pathway rather than the Wnt pathway. The activity of GSK3β and the formation of GSK3β/β catenin complexes in chondrocytes are influenced by an interaction between mechanotransduction and the Wnt signalling. These, in turn, control the cytoplasmic/nuclear distribution of β-catenin which affects the regulation of downstream target genes such ad CD44, fibronectin and some metalloproteinases. CD44 and fibronectin are essential components of cartilage, which are involved in matrix assembly and the maintenance of cartilage integrity.

This study investigates the lives, work and organisation of independent nurses who worked in mid nineteenth century Edinburgh. Little was known of women in this occupation as no systematic study of women engaged in nursing prior to the introduction of formal nurse training has yet been attempted. The research focus lies around 1851 and 1861, the period that preceded the introduction of modern nurse training to the city in 1872. Important earlier developments are traced from the mid-eighteenth century. The study of these nursing careers is set in the context of the history of women’s work, Scottish history, the history of nursing and the history of Scottish medical professionalisation. The dominant influence that impacted on the careers of elite independent nurses was the power of commerce in a market for luxury services in the city. A second significant factor was the professionalising activities of medical men. These were most visible in the contracting opportunities for independent midwives and the expanding opportunities for independent nurses. Thirdly, the most lucrative workplace for the independent nurses was in the homes of the middle and upper classes of the city. In this setting women of superior status closely supervised nurses and they were required to conform to the moral standards of the middle class home. These three influences were applied in an environment of presbyterian probity where gendered roles were an accepted norm, they affected the selected groups of nurses with varying intensity but all three forces are traced in each setting. The study is focused in Edinburgh, a unique Scottish city throughout this period. The medical school and the doctors associated with it were of national and international stature. Patients were attracted from Britain and overseas to consult such eminent men as James Syme and James Young Simpson. Medical care could be described as a local industry. The city was unique in that so much medical activity was focused there. However the opportunities available to nurses in Edinburgh were repeated in other cities where rich patients and their families sought out reputable doctors and both parties needed the assistance of a nurse to complete the pattern of care.

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Gender relations, particularly in the second half of the nineteenth century, were negotiated against the backdrop of a separate spheres ideology. The doctrine assumed a sexual identity for women based on their natural and distinctive biology. These so-called laws of nature asserted a specific female destiny making them peculiarly suited to a reproductive and domestic existence. This thesis sets out to explore why there were good reasons for medical men to welcome the idea of sexual difference, and by what means a number of them sought to frustrate the ambitions of many middle-class women who were questioning their allotted role and actively challenging the legal obstacles blocking their path in achieving equal status with men. Although many women subscribed to the idea of exclusion from the public arena, being quite content to run the domestic sphere, there were significant numbers who were openly demanding changes to their subordinate position. The passage of the Matrimonial Causes Act of 1857, the Married Women's Property Acts of 1870, 1882 and 1884 and the repeal of the Contagious Diseases Acts in 1886 confirmed that many feminists and their supporters were making steady inroads onto male territory. As the lot of middle-class women improved, albeit very slowly, accounting for their distinctive physiology became increasingly difficult to sustain on a rational level. To forestall further any ideas women entertained about moving from their dedicated sphere, some normal female functions were medicalized and many women found themselves directly implicated in the production of pathology. The thesis focuses on the scientific theories and discursive practices that lent support to the notion that women were naturally governed by their reproductive faculty. Their reproductive aptitude became the manifestation of developmental failure, explaining why they had been unable to keep pace with men on their evolutionary journey and achieve equal standing.

This thesis analyses a sample of clinical records of four Scottish asylums, two in Edinburgh and two in Glasgow, in order to study processes of diagnosis and treatment in neurosyphilitic patients <i>circa</i> 1880 to 1930. During this period, <i>treponema pallidum</i>, the spirochaete responsible for syphilis, was discovered. Moreover, the Wassermann reaction to identify syphilitics from blood and cerebro-spinal fluid samples was developed. This test became central to the scientific investigation of the insane, and was increasingly portrayed as psychiatry’s most potent symbol of the emerging era of laboratory medicine. Numerous heroic therapies to treat neurosyphilitic disorders were also tried, including malarial therapy. Therefore in terms of diagnosis and treatment, this period is crucial in the historical development of the relationship between syphilis, psychiatry and medicine. Neurosyphilis is a generic term for all forms of insanity now known to be caused by the syphilitic spirochaete. However alienists, particularly those working in Scotland, responded in complex ways to spirochaete-based reclassifications of forms in insanity such as General Paralysis of the Insane, which was diagnosed in an estimated twenty percent of late nineteenth-century male asylum admissions. This theme is explored by comparing the empirical case note sample findings with the published and unpublished views of Scottish system asylum medical superintendents. It is argued that men such as Thomas Clouston, David Yellowlees and George Robertson assimilated new spirochaete-based aetiologies into pre-existing multifactorial concepts of GPI, which related the disease to the influences of degeneration and urbanisation, ‘fast living’ and ‘excess’. It is argued that their informed medical opinions simultaneously expressed and were also an expression of, wider social, moral and political concerns. The thesis draws upon a broadly social constructionist perspective to illuminate the historical connections between the clinical, pathological and social aspects of neurosyphilitic disorders over the period of study.

This thesis examines print culture and the medical book trade during the middle decades of the seventeenth century. I examine a range of vernacular medical books which predate the publication of Nicholas Culpeper's (1616-54) translation of the London College of Physicians' first Pharmacopoeia (1618) in 1649. Culpeper's English version subjected the official medical knowledge of the professional to his caustic commentary, and launched his programme to produce 'the whol Moddel of Physick' in the vernacular. At the same time the involvement of the Fellows of the College with the book trade during the Interregnum is explored. Examination of the Stationers' Register reveal that Presidents of the College were prepared to endorse English translations of scholarly books and new works by non-Collegiate authors. Through this Register and the 'Annals' of the College I show how two astute London stationers were able to gain control of the rights to the College's Pharmacopoeia. The social relationships between Culpeper and his publishers are analysed, as well as the network of agents responsible for the production and publication of Culpeper's books and their reception. I focus on Culpeper's four principal works - his two translations of the College's Pharmacopoeia (1649 and 1653); his herbal, The English Physitian (1652); and A Directory for Midwives (1651). Their presentation (typography and page-layout), dissemination, and reception are also explored. Apparent from the early history of Culpeper's medical books is the commercialism of the book trade in the 1650s. Medical practitioners and writers exploited print culture to promote their name in the medical marketplace and create a public persona. I discuss Culpeper's activities as an editor and writer, and the fluidity of these texts in response to commercial threats from rival publishers. The development of his work through subsequent editions counters the assumption that printing preserves and fixes a text's meaning. This thesis argues that historical bibliography is essential for an understanding of a book's reception and influence, and I show how print culture was significant to the promotion of vernacular medicine in these years.

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No description available.