From Home to Hospital

This chapter explores the senses and emotions that attended living with and dying from cancer in the early nineteenth century. The archives of The Middlesex Hospital consist of registers of cancer patients from 1792 through to the twentieth century, and a potted selection of casebooks. This chapter, therefore, tells the stories of sixty patients from 1805 to 1836. From these case notes, flesh and blood can be added to the lived experience of cancer and go some way towards recovering the patient voice. We can follow in their footsteps from home to hospital, and in multiple literal and metaphorical ways appreciate the distances they travelled in their ‘cancer journeys’.

Cancer Therapeutics

This chapter investigates the invention, application, assessment, and justification of palliative surgery through the work of two practitioners: Charles Bell (1774–1842) and James Young Simpson (1811–1970). As this chapter will show, close attention to patient pain and suffering was essential to surgeons’ assessments of the efficacy of palliative surgery. Bell and Simpson performed palliative procedures partly because they were concerned by their patients’ suffering and, as suggested in Chapter 2, partly because they wanted to present themselves as enlightened, improving gentlemen. Indeed, the texts analysed here—and the promotion of palliative surgery more generally—provide an alternative portrayal to that of the crude and dispassionate Victorian practitioner.

Cancer Quackery

This chapter brings in patients and practitioners whose views on cancer diverged from those of the London and Edinburgh elites. Analysis of their perspectives demonstrates that the climate of pessimism surrounding cancer’s intractability was not hegemonic, and that various voices of dissent existed both within and without the ‘regular’ profession. This chapter reconsiders the medical marketplace and places the concept of incurability at the centre of patient choice and professional self-fashioning. The suffering that cancer patients were willing to undergo suggest that for many the diagnosis of an incurable disease and subsequent offers of palliative care alone were unsatisfying. Incurability made space for a crowded medical marketplace that catered for desperately ill people and provided treatments of last resort.

Conclusion

This chapter concludes that cancer’s incurability was not just an obstacle to overthrow, but a galvanizing and intellectually provocative idea that shifted medicine, health care, and professional identity in profound and lasting ways. It enabled the construction of professional credentials and community values; turned hospitals into places for treating ‘terminal’ illness; made possible the invention of new forms and rationales of intervention; and brought into being certain modes of investigating the disease such as mapping, the microscope, and discourses of progress and decline. I also suggest that it is almost impossible to research and write a history of cancer without reflecting on its contemporary life. This chapter explores the relationship between cancer then and now and reappraises the twenty-first-century disease.

Introduction

This introductory chapter shows that it was in the nineteenth century that cancer acquired the unique symbolic, emotional, and politicized status it maintains today. Not only did it maintain a not-insignificant incidence, cancer also played a culturally significant role in nineteenth-century life. Then, as now, observers tied cancer to environment, diet, and morality; and malignancy was a prominent feature of the social, political, and cultural landscape. This chapter introduces the two main interrelated concerns of the book: one, the lasting formation of cancer’s identity as an uncommonly incurable and therefore uncommonly dreadful disease; and two, how cancer was made into a malady of modern life, a pathology of progress, and a product of civilization.

Making Cancer Modern

This chapter analyses and assesses the medical practitioners and social commentators who searched for an explanation for the new ‘cancer epidemic’ in Victorian Britain. While Chapters 5 and 6 looked at medical men who, using a range of techniques and technologies, attempted to decode the aetiology of cancer and explain and arrest its expansion, the limited success of these efforts prompted some observers to suggest that perhaps the origin of malignancy could be found in the very fabric of modern society. If it was not latent in the landscape, nor a waxing and waning infectious disease, then maybe cancer’s increasing incidence was a sign of some change in the bodies and lifestyles of the nation and its inhabitants.

Cancer under the Microscope

This chapter reveals how mapping was only one of the tools deployed to decode the ‘cancer problem’ in the latter half of the nineteenth century. Running parallel to the activities of Haviland, Moore, and Green, biologists, pathologists, and histologists took up the microscope with gusto and spawned a vibrant debate among cell theorists, bacteriologists, and parasitologists. This chapter thus traces the introduction of the microscope into the landscape of cancer theory and practice, explores the development of cell theories of malignancy, and interrogates the many and various ‘germ theories’ of the disease. It argues that despite their close relationship with the microscope and its scientific and progressive associations, all three theories appealed in part because they recapitulated and reframed very old ideas about cancer’s causes and characteristics.

Incurability and the Clinic

This chapter shows how the hospitalization of cancer gave the care of the disease new legitimacy, tied it closely to the investigative and charitable projects of the metropolitan medical elite, and provided cancer with a presence in London’s built environment. It was in this early nineteenth-century moment that the disease moved out of the confines of the sickbed and entered the culture, politics, and social world of the early Victorian metropolis. The chapter reveals how, because of their new, concentrated, and hospital-based study of the disease, the capital’s medical elite defined cancer as an incurable malady and as a problem that they, as a collective, needed to overcome. It argues that the hospitalization of the disease codified cancer and transformed characteristics—such as incurability—that had long been observed by practitioners into essential, identifying features.

Counting and Mapping Cancer

This chapter explores the practice of collecting cancer statistics and examines the meanings and implications of the nascent idea of the ‘cancer epidemic’ in the mid-nineteenth century. In response to the supposed increasing incidence of cancer, some medical men sought strategies beyond the clinic to elucidate the evasive malady. The continued therapeutic futility with respect to cancer provoked a diversification of investigative efforts, and elements of the medical community refocused on the disease’s causes, prevention, transmission, and potential communication. This chapter explores the ways in which practitioners interested in cancer—little-known characters like Alfred Haviland, Charles H. Moore, and Charles E. Green—mapped cancer incidence, understood the disease to be produced by rural environs, and conceptualized the disease spatially and according to scale.