The Cancer Problem: Malignancy in Nineteenth-Century Britain by Agnes Arnold-Forster (review)

Cancer is so central to the disease landscape of the twenty-first century that it may come as a surprise to learn that the first cancer-specific institution in Britain opened in 1792, at the Middlesex Hospital in London. Certainly, there has been no dearth of historical interest in cancer. Robin Wolfe Scheffler’s A Contagion Cause: The American Hunt for Cancer Viruses and the Rise of Molecular Medicine (2019) and Nathan Crowe’s Forgotten Clones: The Birth of Cloning and the Biological Revolution (2021) explore elements of the twentieth-century drive to understand the viral cause of cancer and its varied biomedical cures. These recent works, both of which are significant in their own right, go to show, however, that we continue to locate the modernity of cancer, and the cancer of modernity, in the twentieth and twenty-first centuries. Our version of cancer is “a potent metaphor for anything evil, malevolent, or menacing” (Arnold-Forster 15), but we often assume that it was debates and experiences in the twentieth century that led to the rise of this moral valence around the disease.

Agnes Arnold-Forster’s The Cancer Problem: Malignancy in Nineteenth-Century Britain offers a fundamental alteration to what we think we know about cancer. In the process of this historiographical realignment, Arnold-Forster also asks us to rethink many of the central tenets of the cultural history of medicine in nineteenth-century Britain. Scholars have long framed the Victorian era as the epidemic century, and disease-based studies proliferate on cholera, tuberculosis, typhoid fever, and smallpox. By focusing on epidemic and largely infectious diseases, Arnold-Forster argues, we miss crucial elements of the scientific complexity of understanding disease and the emotional landscape of doctors and patients in the nineteenth century. Viewing cancer as an “integrated disease category,” Arnold-Forster interrogates the broader cultural meanings of the disease that went beyond the site-specific understandings of cancer that tend to dominate popular thinking today (10).

By placing cancer at the center of the history of nineteenth-century Britain, Arnold-Forster paints a different portrait of debates around medical professionalization, the rise of hospital medicine, medical statistics, microscopy, and epidemiology. After reading The Cancer Problem, we might still argue that cancer is “the modern disease par excellence,” as Roy Porter long ago argued (qtd. in Arnold-Forster 4). But, as Arnold-Forster shows, the modernity of cancer was largely a product of the Victorian period. Historians and literary scholars alike will find this book full of fresh insight about the ways that cancer was central to ideas of the self and the nation in Victorian Britain, and how cancer played a role in delineating categories of gender and race, progress and decline.

Key to understanding Victorian notions of cancer, Arnold-Forster shows, is the complex way in which the disease was framed as incurable. An unstable, shifting category like cancer itself, incurability was a double-edged sword, referring to the despair of patients, the emotional and material nature of the disease, and the promise of new therapeutic, sensory-based interventions. Constructing cancer as incurable, then, was “a galvanizing and intellectually provocative idea that shifted the concepts and practices of medicine, health care, and professional identity in profound and lasting ways” (3). Victorian cancer, in other words, recast the emotional landscape between doctors and patients.

The Cancer Problem is organized into two parts, “Characteristics and Cures” and “Causes,” and takes readers on a fascinating journey from cancer care at Britain’s first cancer-specific institution of the late eighteenth century to the First World War. The book situates cancer in three overlapping spatial geographies: the home, the hospital, and the laboratory. Part 1 begins with cancer patients and cancer practitioners, using a case study of over sixty cancer patients at the Middlesex Hospital from 1805 to 1836. Chapter 2 turns to the broad pattern of hospitalization of cancer in nineteenth-century London, showing how urban aggregations...