Alanna Skuse, Constructions of Cancer in Early Modern England: Ravenous Natures (London: Palgrave Macmillan 2015) viii + 219 pp. £15.00 Pb, £20.00 Hb. ISBN: 978-1-137-48752-0
Alanna Skuse’s Constructions of Cancer is a cultural history of a disease that we tend to think as modern, but which has a long and rich past. Skuse uses a variety of sources – medical, literary, personal accounts – in order to reconstruct what cancer meant to sufferers and medical practitioners in the period from 1580 to 1720. The most emphatically maintained statement in the book is that, in the period in question, cancer could be both of the body, rooted in humoural abnormality, and also hostile to it, a foreign entity that maliciously devours it. Appreciating this duality reveals the nature of early-modern cancer and also the flexibility of early-modern medical thought.
Skuse begins her first chapter by looking at what was meant by ‘cancer’. She reminds us that ‘cancer’ was not a monolithic term but one that was shaped by understandings of pathogeny, cultural metaphors, and ideas about gender, society, and the body – including the social body. Tumours could result from the stagnation or corruption of black bile, but they also ‘behaved’, that is, presented a clinical image that could be made legible by analogy and reference to concepts beyond the body. For instance, the crab, the oldest image associated with cancer and one that is etymologically linked to it, could render legible the harrowing action of cancer on the body as a disease that ‘bites’, ‘eats’ or, more precisely, ‘gnaws’ away at flesh. Such ‘zoomorphic behavioural characteristics’ (2), as Skuse terms them, are an integral part of the understanding of cancer and she further addresses them in a later chapter.
The second chapter introduces a recurring theme in the book: the gender-specificity of the disease and the female breast as the paradigmatic locus of cancer. Female susceptibility to cancer depended on both physiological and circumstantial conditions. On the one hand, the early modern ‘distrust and ambivalence towards sex-specific organs’ (53), especially the womb, lent itself easily to physiological explanations for a disease that was hidden and duplicitous. On the other hand, the life conditions associated with the female experience in the period could be construed as risk factors, or could lead to speculation about the causes of the disease. The connection between bruising and cancer, for example, could raise questions about domestic violence and the hidden conditions of women’s lives. Thus, an illness that was characterized by bodily secrecy could open women’s private lives to social exposure and conjecture.
The third chapter elucidates the book’s subtitle: ‘ravenous natures’. The images of wolves and worms are explored as fitting analogies for a disease that emaciated the body as it progressed. Cancer seemed to devour the patient from within, either aggressively or insidiously and parasitically. These associations were not only figurative. Some medical authors suggested that tumours did, in fact, contain tiny worms. Others subscribed to ‘meat cures’: applying animal flesh directly on the body in an effort to entice the wolf of cancer away from the patient’s body. Such assertions and treatments posited cancer as a separate entity, foreign and detrimental to the body. This was further enhanced by the semantic and cultural heritage of the images of wolves and worms. Studying these images and their significance, Skuse provides a mapping of the qualities centring on cancer. Cancer was secretive, duplicitous, and devouring – all of them, terms on the cusp between the figural and the literal.
Cancer’s most defining characteristic, its malignancy (Chapter Four), was also a concept that fluctuated between the categories of literal and figural, or medical and cultural. It could suggest both ‘neoplasmic growth’ and also a ‘broader sense of ill will’ (75). Indeed, as Skuse explains, ‘cancer’s ability to spread through the body was indistinguishable from the malignancy of villainous individuals or factions’ and the danger they posed to the body politic (87). Accordingly, the malignancy of cancer entailed, almost, an element of agency. As a malignant disease cancer was construed as ‘purposefully evil’ (89). Collectively, the zoomorphic imagery surrounding cancer and the multiple connotations of the qualities that characterized it, constructed a disease in semi-sentient terms: actively malicious, rebellious against the body and ‘bent on’ extinguishing the self. In turn, this affected the ways cancer was managed or cured at the time. This is the theme of the remaining two chapters.
Chapter Five is devoted to non-surgical methods of treatment. Here Skuse reviews dietary advice, unguents of specific ingredients, and also the more drastic pharmaceutical measures of mercury and arsenic. These cures were not necessarily tailored to cancer. Rather, they derived from a long tradition of therapeutics such as the prominent place that diet and regimen held within humouralism, or the principle of curing by using ‘like against like’. However, in their choice and application we perceive the connection between discursive constructions of cancer and its physical experience. For instance, a ‘soft cure’ may have been selected, or preferred, over more drastic measures so ‘as not to stir the capricious, ill-tempered cancer’ (105). On the other hand, the use of more extreme or radical cures could be justified in the fight against a disease that was malicious and intractable. Nowhere was this adversarial attitude more prominent than in the case of cancer surgery, the subject of the last chapter. Focusing on mastectomies, Skuse returns to a gender-sensitive argument. She argues that the male surgeon’s intimate knowledge of the female body and access to it incited social suspicion over their motivation and practice. This was fuelled by the ambiguous professional status of surgeons in the period. This reading of gender and power dynamics is particularly apt here as evidenced by the language of desire and submission that some medical professionals used in their treatment of female patients and their dealings with the disease.
Overall, this book offers a nuanced overview of the way early-modern cancer was understood. However, its usefulness is likely to extend beyond the history of cancer per se. Skuse articulates very clearly the dialogic relationship between disease and culture in early modern context, and she does so in a way that interests both the medical historian and the literary scholar. In addition, literary scholars and cultural historians will find here a lot of information that speaks to cancer’s capacity to denote disorder in the early-modern body politic, social anxieties over treachery – especially political treachery – and moral frailty. Lastly, as she is careful throughout to decipher the physiological signs in constructions of cancer, this book will prove valuable to the study of other early modern diseases that converged on the same, or similar, characteristics.
Lina Minou, Loughborough University