Bulletin of the History of Medicine

In 1971 Richard Nixon announced a “War on Cancer”; fifty years later Antonio Guterres, the Secretary-General of the United Nations, declared that “the world is at war with COVID-19.” Both drew on the familiar trope that medicine is a fight against disease, aimed at disarming and defeating enemies that threaten from within and without. When and how did this martial metaphor emerge and become naturalized? Lorenzo Servitje’s Medicine Is War argues the answer can be found in the early nineteenth century, beginning with the arrival of localized pathology, [End Page 272] when diseases became alien entities, and then from the 1880s with the identification of invading germs and rogue cells. Preventive public health measures were forms of defense and clinical treatments forms of offence. But Servitje makes another claim. Medicine as warfare became dominant, not just in the profession, but in the wider culture through literature, which “allowed for a broader reach and for orders of complexity through which to permute the martial metaphor to various venues and audiences” (pp. 2–3).

The book is in three parts. Part 1 covers the 1820s to the 1850s, focusing on miasmas and contagion theory in Mary Shelley’s The Last Man (1826) and Charles Kingsley’s Two Years On (1857). Part 2 moves from the 1880s to the early twentieth century and the impact of cellular pathology, bacteriology, parasitology, immunity, and eugenics in Bram Stoker’s Dracula (1897), Conan Doyle’s detective fiction and other writing (1887–1927), and Joseph Conrad’s Heart of Darkness (1899).The book ends with two codas: one on the modern “fight” against infection, especially microbial resistance to antibiotics, and diary reflections on completing the book in the time of COVID-19.

Set in the twenty-first century, The Last Man was an apocalyptic story of a pandemic spreading around the world, causing the near elimination of the human population, almost literally to the last person standing. Its model was the 1817–24 cholera pandemic. Servitje shows, in detailed textual analysis, that Shelley had a fine grasp of the complexities of contemporary medical thinking around miasmas, contagion, and vaccination, as well as critiques of medical and political responses. The chapter demonstrates the author’s approach, which is to mine medical sources for the ideas that his authors drew upon in their use of the “medicine is war” metaphor. The Napoleonic Wars and their medical problems are shown to have fostered the notion of pandemics as invaders and parallels between protecting army and civilian health. Did Shelley’s book have “a broader reach”? Unlikely. It was savaged by reviewers, and her publisher was disappointed after the success of Frankenstein a decade earlier. Indeed, later and greater cholera pandemics did not prompt the novel’s reissue, which had to wait until 1960.

Two Years Ago (1857) is the author’s choice to show how “medicine is war” was mobilized at mid-century in the wake of successive cholera pandemics and the Crimean War. The book’s central character, Tom Thurnall, is involved in a heroic struggle for social and sanitary reform. War on disease is also war on filth, pollution, and poverty. The deep reading of novel is supplemented by discussion of Kingsley’s other writings and speeches, where conflict is accompanied by a hoped-for consensus from shared Christian values. The links between public health and military medicine at this time are well-known and exemplified by Edmund Parkes’s Manual of Practical Hygiene (1864). However, an opportunity is missed to say more about clinical medicine and struggles against injuries and wound infection in individuals. Lister, for one, spoke of using antiseptics to “combat putrefactive microbes.”

The chapter on Dracula covers quite familiar ground, but the author imaginatively finds new examples of Stoker drawing upon medical issues, from the Contagious Diseases Acts, through germs to degeneration. The...