The history of general paralysis of the insane in Britain, 1830 to 1950
This thesis explores the history of ideas about, and responses to, general paralysis of the insane (GPI) - specifically in the context of the developing profession of psychiatry in Britain. It considers GPI as an objective disease entity whose subjective definition was nevertheless open to negotiation; for example, in deciding how central was overt insanity, or how GPI should be differentiated from the allied disease of tabes dorsalis. It explores how psychiatrists' interest in organicism and the science of medicine - and their attempts to raise the status of their specialty - both informed their understanding of GPI, and allowed them to promote it as a flagship disease for their profession. Nevertheless it draws attention to the gap between such claims and concrete practical advances which the disease fostered. The thesis considers changing causal explanations for GPI: first, in relation to the evolving image of the typical general paralytic patient; and second, in relation to the credence attached to different forms of causal evidence such as pathology, statistics, and laboratory medicine. It suggests how assessment of this evidence might have been informed both by professional aspirations and by pervasive cultural concerns such as fear of syphilis and degeneration theory. The thesis studies the use of malaria therapy to treat GPI in Britain, and uses this episode to explore a number of themes: early twentieth century ethical attitudes to heroic treatments; perceptions of 'cure'; and the change in emphasis from asylum care to community care. Finally, it considers ideas about the epidemiological history of the illness - from early twentieth-century theories about the evolution of infections, to Edward Hare's hypothesis of a neurotropic epidemic; and considers how the views of disease as objective entity, and disease as cultural construct, might be reconciled in the context of GPI.