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This dissertation sought to investigate civic surgeons and medical practice in the eighteenth-century Austrian Low Countries, the area we now know as Belgium and Luxemburg. This field of research has been neglected so far, and little literature has been written for this geographical area, which does not do its history any justice. During the eighteenth century, the Austrian Low Countries fell under the rule ofthe Austrian Habsburg monarchy, an area which was influenced by the eighteenth-century Enlightenment. This affected also the medical world. Both the national and local governments interfered increasingly into the affairs of the general public, including the practice of medicine. Stricter rules and controls were set in relation to the training and settlement requirements for surgeons. However, the individualism of the cities and provinces made central rule difficult and regulations still varied from city to city. The relative political, religious, and socio-economic stability enhanced the status of artisans, including surgeons. More surgeons managed to climb up the medical ladder, making them potential influential members of society. Accordingly, the professional medical boundaries between surgeons and physicians were more permeable than in some other places in Europe. The emancipation ofthe surgeons was the biggest change in the medical landscape ofthe eighteenth-century Austrian Low Countries. More surgeons undertook further study, skilled themselves, and researched into medical topics. Particularly midwifery seemed to have been ofgreat concern. Surgeons became actively involved in setting up and teaching practical and theoretical midwifery classes for midwives and surgeons. In their actual surgical practice, surgeons, unlike physicians, were confronted with grassroots medicine. Particularly in emergency cases, surgeons needed to be creative, sometimes crossing the boundaries oftheir medical profession in order to help a patient. This inventiveness and their empirical findings were often the basis of change In daily

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This thesis uses previously unexamined case material from the Maudsley hospital to put forward three central propositions. Firstly, I argue that the implementation and repeal of mental deficiency law in Britain had a direct influence on the establishment of ‘autism’ as a category within child psychiatry. Secondly, I propose that all research in childhood autism has its direct antecedents in research into adult schizophrenia and that the category can never be independent of this history. Finally, I describe how the meaning of autism shifted from a representation of excessive phantasy life and hallucination to a representation of a lack of phantasy life. I argue that this shift was contemporaneous with a growth in epidemiological and statistical studies in child psychiatry from the mid-1960s onwards. The first chapter describes how the Mental Deficiency Act of 1913 led to a major increase in the numbers of children institutionalised on account of their mental state. Chapter two describes childhood psychosis treatment and research at the Maudsley. The 1959 Mental Health Act saw the de-institutionalisation of over 141,000 adults and children in deficiency institutions, most of whom had been certified as ‘defective’ in childhood. This prompted a rapid increase in epidemiological and statistical studies at the Maudsley. These studies were attempts to quantify the social problems which resulted from this major demographic shift. Victor Lotter’s 1964 study of autism established a solid foundation to the category of autism underpinned with epidemiological and sociological data. Chapter three examines the significance of this transition. The final chapter explores the growth in diagnoses of autism, ‘autistic features’ and related conditions in children from the mid-1960s onwards.

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