In The Cancer Problem: Malignancy in Nineteenth Century Britain, Agnes Arnold-Forster addresses cancer's relationship to medical professionalization. She also offers us a sense of patient expectations and therapeutics, both those considered medically legitimate and those considered less so. She also covers theories of causation and technologies of visuality (the microscope) and of visualization (the map). Cancer was increasingly constructed as an incurable disease of modernity, as Arnold-Forster clearly shows, and that judgment was intertwined with the professionalization of medicine and the development of visual research tools.

As Arnold-Forster notes, the few histories of cancer in the period that have been produced to date have focused on site-specific cancers, often of the breast or female organs. These tumors were among the most studied, especially in the early part of the century, in part because they were often the most visible (in the gross anatomical sense). The materials she draws upon in the book are also preoccupied with these cancers, as they were ones that frequently ended up in the hospital records, but she treats cancer as an “integrated unit” (11), as the period tended to see cancers on a continuum rather than as separate diseases.

Cancer in the nineteenth century was marked by its incurability. This incurability, Arnold-Forster argues, became “productive” (3), as medical professionals defined themselves in relation to palliative surgery and other care, a research paradigm aimed at long-term knowledge development, and the construction of specialized networks and sites of expertise. This included the cancer hospital as a place of uniquely appropriate care and research. Beginning with the archive of records from the first British hospital dedicated to cancer, Middlesex Hospital on Mortimer Street, London, Arnold-Forster attends to how the doctors constructed not only their therapeutic and professional roles but also their personae as emotional, sympathetic caregivers. Founded in 1792, this hospital became a place where patients went to receive palliative care when it became difficult for them to remain at home. Drawing on the records of sixty patients in the period between 1805 and 1836, the opening chapter gives a clear sense of what it might mean to live the reality of having or caring for cancer there. Cancer's acknowledged incurability, Arnold-Forster argues, gave patients perhaps more agency in defining the meaning of their illness and its care. Because doctors could not offer a cure, a cancer diagnosis opened a dialogue about quality of life. Arnold-Forster rounds out this part of the book with a look at the medical marketplace and “quack” remedies (109), though she is careful to describe a continuum in which the line between approved scientific treatments, experimental treatments, and intentionally fraudulent practice was not clearly defined. Then, as now, the seriousness of the disease and its outcomes, as well as the frightening nature of even palliative surgery, made patients eager to try a range of treatments they might not otherwise have contemplated.

Whereas historians have tended to see cancer's definition as a disease of modernity emerging in the twentieth century, Arnold-Forster shows that this idea has an older lineage, one traceable to mid-nineteenth-century technologies of visualization. In a particularly strong chapter in the second half of the book, she explores the practices of statistical modeling and medical mapping. Cancer theories were deployed along the same racial and imperial lines as those of other nineteenth-century diseases, particularly the more well-studied context of infectious maladies. For example, medical mapping suggested that Black people were “almost immune” to cancer, and this was explained by their “savage” nature and lifestyle (213). Next, she shows the developing use of the microscope as cell theories became influential in Britain, especially after the late 1850s, when Britons took up Virchow's argument that cancer cells were healthy cells gone awry rather than something alien to the body. By the 1890s, histological examination of cancerous tissue under the microscope became standard. Still, Arnold-Forster makes clear, the use of the microscope was not uniformly seen as a simple advance. Many practitioners thought the microscope should always be subordinated to clinical study of the patient and tactile examination (170). Arnold-Forster shows there were substantial investments in seeing cancer through the lens of infection and as something deriving from a “bacillus” (176) or a “parasite” (182), once germ theory became popular. The map and other statistical tools arising in the period of medical and moral environmentalism and epidemic disease framed cancer as a public health problem and suggested an etiology having to do with location: there were “cancer houses” (156) and cancer soil environments. The disease appeared to be concentrated in areas with rivers and streams, thus framing the otherwise exemplary Lake District as being as dangerous as the Thames Valley. Though London was mapped as having a high incidence of cancer, this was, in a marked reversal from the mapping of many other diseases, not referred to its population density, but its rivers. In addition, as race served as a marker for position on a hierarchy of civilizational development, the implications of international cancer maps seemed clear to their makers. Cancer was most reported in the European centers of civilization; ergo, cancer was a disease of modernity and of civilization.

Arnold-Forster does not concern herself with literary or (for the most part) artistic renditions of cancer. Only occasionally does she engage with the political ramifications of theories and metaphors of cancer, but when she does pursue that discussion, the results are quite interesting. No one book can do everything, and this book will serve as a strong foundation and springboard for work of that nature. The Cancer Problem offers an excellent, well-researched, and often surprising history of this disease and the professionalization surrounding it. There have been few historical studies of cancer in the nineteenth century, and every chapter of The Cancer Problem offers original insights.