^I. Masculinity and Militarism in the Sanitary Era

The genealogical origins of war as an imaginative and rhetorical trope in British medicine can be located in the masculine cultures of early nineteenth-century reform. During the later eighteenth century, medical practice was, for the most part, gendered along the lines of polite and civil gentility.Footnote 22 However, as the number of practitioners increased in the decades after the end of the Napoleonic wars and as pressure grew from among the lower ranks for the structural and political reform of the discipline, medical discourse took a distinctly masculinist turn. Through the languages of “brotherhood” and upright, “manly opposition,” medical reformers redefined themselves as a discrete, professional body, distinct from the penumbra of health care, and asserted their rights as independent men, both against the corporate aristocratic elite and within the social field as a whole.Footnote 23 Perhaps the clearest exponent of such language was the radical general practitioner and editor of the Lancet, Thomas Wakley, whose frequently vicious and libelous attacks on “Old Corruption” in medicine mirrored the language of his political associate William Cobbett.

Although masculine rhetoric was prevalent within medical reformist discourse as a whole, it was in the field of sanitary medicine that the particular tropes of a heroic and militarized masculinity were elaborated and deployed. The first collective medical engagement with the health and social conditions of the poor took place during the cholera epidemic of 1831–32. Traditionally, medical practitioners had felt little compulsion to take an active role in mitigating epidemic disease.Footnote 24 During the cholera epidemic, however, doctors and surgeons sat on local boards of health and often found themselves treating the very poorest members of society in temporary cholera hospitals or in the homes of the sick, often without charge.Footnote 25 The medical response to cholera was undermined by divisions concerning its epidemiology and by popular hostility engendered by the Anatomy Act (1832), which allowed medical practitioners access to the unclaimed bodies of the poor for the purposes of dissection and which fueled popular distrust of their activities. Nevertheless, in more “elevated” social circles at least, it served to enhance the moral authority of medicine.Footnote 26 At a meeting of the local board of health in August 1832, for example, the Dean of York praised the “zeal and activity with which they [medical men] had come forward to stay the progress of the disease; that they had exposed themselves and their families to the most imminent danger of contagion; that they had passed sleepless nights, in affording assistance to their fellow creatures; and that they had stood up between the dead and the living, and stopped the plague.”Footnote 27

Yet if the medical response to the cholera epidemic of 1831–32 had been a broadly collective one, an expedient response to a national crisis, then the routine business of sanitary medicine would fall to a more specific group of practitioners. In 1834, the Poor Law Amendment Act created the post of District Medical Officer to minister to the health of the lower orders. At one level, this was a hugely significant development, for in the words of Chris Lawrence, the post of District Medical Officer constituted “the principal means by which medicine was harnessed into the running of nineteenth-century society.”Footnote 28 At another level, however, the professional status and identity of the District Medical Officer were deeply vexed. The preserve of the struggling general practitioner, the position was poorly paid, tendered out to the lowest bidder. The authority and autonomy of the District Medical Officer were likewise limited, undercut by the contempt with which he was so often treated by both lay guardians and the medical hierarchy alike.Footnote 29 It is this liminality of identity that provides the key to understanding the rhetorical elaboration of a militarized medical masculinity. As Priti Joshi's study demonstrates, Edwin Chadwick's intellectual dominion over the poor can be read as part of an attempt to construct a social and gender identity that, in the absence of a stable career, derived authority from merit and expertise rather than from the aristocratic values of kinship and patronage to which he had little access.Footnote 30 The same can be said of those appointed to the positions he created. Undervalued by the state and disdained by their socially superior colleagues, poor law surgeons shaped a solidly middle-class masculinity that, in emphasizing the values of disinterested public service and heroic self-sacrifice, worked against their marginalization, even feminization, as economically dependent supplicants. As with Chadwick, this identity was directed upward, against the self-interested medical elite and aristocratic government that neglected them, as well as downward, against the poor, whose idleness and amoral complicity in their own pestilential environment they sought so vigorously to reform.

Although they bubbled away under the surface of medical discourse throughout the later 1830s, these issues really came to a head during the social and sanitary crises of the “hungry” 1840s. An increased popular interest in the social conditions of the poor, exemplified by the extensive circulation and widespread impact of Chadwick's Report on the Sanitary Condition of the Labouring Population of Great Britain (1842),Footnote 31 highlighted the role of the poor law surgeon as the figure in respectable society most consistently exposed to the blighted lives of the “lower orders.”Footnote 32 So too did the epidemiological situation. Typhus remained virtually endemic in many urban areas of Britain, while in Ireland it combined with the debilitating consequences of the famine to cut swathes through the population.Footnote 33 To make matters worse, the dreaded scourge of cholera returned to British shores once again in the autumn of 1848, encouraging a hitherto ambivalent Parliament to pass the Public Health Act.Footnote 34

Rhetoric aside, it is clear that poor law surgeons did suffer from relatively high levels of mortality in this period. Medical journals carried a consistent stream of obituaries and notices recording the deaths of practitioners who had, it was believed, contracted disease as a consequence of their work with the sick poor. The situation in Ireland was particularly severe. In September 1847, the Lancet announced that “not a week elapses but some Irish surgeon falls victim to the pestilence which has now so long prevailed … and yet the individuals who are struck down in their endeavour to aid their afflicted neighbours fall disregarded by the legislature.”Footnote 35 Matters in Britain were not much better. In one week alone in January 1848, the Journal of Public Health recorded the deaths from typhus of ten practitioners “in the Discharge of Public Duty.”Footnote 36

It was in this period, then, that the imagery and rhetoric of heroic self-sacrifice was first most widely articulated, not only with the death of Dr. Lynch but in the obituaries of men such as Robert Storrs, surgeon to the Doncaster Union, which recorded how he had “died on the field of duty,” or that of Joseph Williams of Stokes Croft in Bristol, which claimed that “his life was glorious and his death triumphant.”Footnote 37 In medical lectures, such language was similarly prominent. Speaking to the London Hospital Medical School in October 1847, George Critchett praised the activities of medical men in the field of sanitary reform, claiming that “with all the heroism of the champion, and, alas! too often with all the faithful devotion of the martyr, have some of the brightest ornaments of our profession pursued their untiring labours amid the ravages of contagious fever. … They seem to realize the glory of the prophet of old, when he stood between the living and the dead, and stayed the progress of the destroying angel as he swept through the armies of Israel.”Footnote 38

Although these discourses emerged within the field of public health and were intimately linked to a specific set of political grievances, their imaginative appeal was such that they embraced situations and individuals unconnected to the immediate sanitary crisis. In December 1845, for example, the Lancet ran a story on “the heroic Sidney Bernard,” an English surgeon who died after having voluntarily boarded a plague-stricken ship in Madeira.Footnote 39 Similarly, in recording the 1854 death of a Dr. Cunningham, who was swept away trying to save the passengers of the shipwrecked Tayleur, the Lancet announced that “it is impossible not to be deeply moved by heroism like this, and it is with a deep sense of admiration and sympathy that we express our regret at the fate of so brave and worthy a professional brother.”Footnote 40 Indeed, so pervasive was the language of medical heroism that even more routine accidents were subject to reinterpretation. When the University College London medical student John Phillips Potter died from an infection contracted during dissection, the professors and students of the university decided to erect a statue to him.Footnote 41 The Lancet declared that “the victims of dissection ought to hold a distinguished place among the martyrs to science and knowledge: Braving the dangers of this death is one of the silent heroisms of our profession, which should make the medical man feel the pride of courage and endurance; and we are the more reminded of these things at the present time, when numbers of professional men, in this country and in Ireland, are falling victims to their attendance on the pestilential fever produced by famine.”Footnote 42

As is apparent from the Lancet’s elegy to Potter and from Critchett's speech to his students, contemporary medical discourse often combined active, intrepid, and warlike languages of courage and bravery with more passive languages of self-sacrifice, victimhood, and martyrdom. These more feminized and quasi-religious tropes were tinged by the domestic dimensions of professional identity and by the duties of pastoral care that linked medicine to the church. Indeed, as a model for medical professional identity, the church seemed the most obvious choice, just as martyrdom seemed the most obvious template for medical heroism. There was, after all, very little that poor law surgeons such as Lynch, or medical students such as Potter, could have done to avoid their fates. Death from disease was unfortunate and accidental, rather than a willful act of reckless daring. By invoking the image of martyrdom, their deaths could be sublimated into ennobling exemplars of a pervasive, if “silent,” medical heroism. The dead man became a source of collective “pride” in duty, as opposed to an object of mere pity or sympathy. In the case of Potter in particular, victimhood and martyrdom also had other rhetorical and political uses. In the wake of the deeply controversial Anatomy Act, the language of martyrdom served to counter a popular caricature of the medical man as a heartless dissector of the bodies of the poor.

What is remarkable, then, is not the prevalence of religious imagery and languages in contemporary discourse but the fact that it was the military paradigm, rather than the ecclesiastical, that came to dominate reformist cultures of medical self-representation. In anticipation of a second cholera epidemic, for example, Wakley asked: “When [cholera] visited this country before, upon whom did its burden of anxiety, expense, and danger, principally fall? Upon medical men. And now, a second time, this destroyer is coming westward over the globe … and a second time the medical profession, to the number of nearly thirty thousand, like a devoted army, will have to stand, in the danger of contagion, between the people and this fatal pestilence.”Footnote 43

Given what I have said about the ambiguous position of the army in British society in the 1840s, why would Wakley, a political radical and Chartist sympathizer, choose to compare the medical profession to the army? Of course Wakley did not invoke an image of the British army, per se, but rather a metaphoric abstract, suggesting that one might well employ military analogies without expressing support for the status quo. Nevertheless, the use of such language might also suggest that Myerly's “martial vision” was well established by the late 1840s and that his early nineteenth-century chronology is not quite as inappropriate as his critics have alleged.Footnote 44 After all, in this period the army was both less visible as a potentially repressive domestic force (there were only nineteen regular battalions stationed on British soil in 1841) and also at its most militarily active, participating (along with the troops of the East India Company) in a range of foreign and imperial conflicts, including the Afghan (1838–42), opium (1839–42), and Sikh wars (1845–46, 1848–49).Footnote 45 This combination of heightened popular awareness with relative imaginative distance (except, perhaps, as mediated through the spectacular form of parades and displays) may well have helped to shape more popular visions of the army, comparable to those of the Royal Navy.

More important, for my purposes at least, the military paradigm performed a set of political and rhetorical functions within medical discourse that the religious trope simply could not. First, by emphasizing courage and valor at the expense of domestic or pastoral care, it shaped an active, public, and overtly masculine identity that not only rendered medicine distinct from the church but, crucially, was comparatively less accessible to women involved in the sphere of health care, be they nurses, midwives, or even mothers, sisters, or daughters attendant on the sick. Militarism was thus a potent tool of identity formation, constructing medicine as a unique, bounded, and masculine activity.

The second function of the developing military paradigm was the alignment of medical identity with the image of an army that was a truly national institution, representing and defending the interests of the nation as a whole. In contrast, the religious sphere remained divided along sectarian lines between Anglicans, Catholics, and dissenters, as well as between the Episcopal Church of England and the Presbyterian Church of Scotland.Footnote 46 By aligning themselves with the army, medical practitioners (in particular poor law surgeons) were therefore able to claim that they too represented the state and that, like soldiers, they were required to lay down their lives in the national interest as defenders of the “people.”

While cultivating the symbolic capital associated with the army, however, such analogies also served to highlight the discrepancy between medical and military service. As I have suggested, reformist visions of meritocratic reward were just that, visions. They presented things as they should be, not as they were. In the majority of cases in which medical writers employed the trope of militarism, the public and governmental estimation of military sacrifice was therefore contrasted with the absence of an equivalent appreciation in matters medical. “If they survive the hazard of war,” the Lancet claimed of military officers in 1853, “applause, wealth [and] high places are their reward. If they perish, national honours are decreed to their memories, history records their devotion and their ends.” By contrast, poor law surgeons and sanitary doctors, who engaged in “another kind of public duty, more perilous than war … sacrific[ing] their health and all social comfort,” received no such plaudits.Footnote 47 As with many reformist causes, France provided an enviable contrast to the situation in Britain.Footnote 48 Throughout the later 1840s, the Lancet regularly reported on the bestowal of medals and other such honors on French medical men. Commenting on the award of the Legion d’Honneur to the staff of the Parisian hospitals for their service in the cholera epidemic, it lamented that “honorary distinctions are so much less frequently awarded in this country. … They are great incentives to zeal and emulation. … Cheap to the giver, they are highly valued by the recipient.”Footnote 49

Medals and awards, although desirable, were not the most important issue, for what most animated medical reformers was the financial security of familial dependants. With a marked increase in medical mortality, it is perhaps little surprise that the 1840s saw the proliferation of medical benevolent societies and subscription funds to support the families of deceased medical men. However, those who presented medicine as a public office did not regard such matters as the responsibility of the profession. “The widows and orphans of the naval and military services are provided for by the state,” the Lancet observed, while those of “medical practitioners … [who] fall in the actual service of the public … have but the most scanty, the most precarious, and the most partial security against absolute want and misery. … If a man fall in the service of the State, it is the duty of the State to adopt and protect his widow and orphans.”Footnote 50 Although certainly a genuine concern, the consistent emphasis placed on the fate of familial dependents by medical commentators also possessed great rhetorical power, for the image of the grieving widow and absent paterfamilias struck at the heart of an early Victorian conception of masculinity wherein the affective claims of the domestic sphere underwrote the nobility of public duty.Footnote 51

Needless to say, these visions of medicine, and of the kind of state to which it might be allied, were by no means universally shared. Most medical practitioners, including almost all reformers and even some of those more elite practitioners who earned their livings exclusively from private practice, supported a degree of state recognition, be that licensing and regulation or merely a greater appreciation of medicine's contribution to the social good. Few, however, even within the reformist camp, would have wanted medicine to become a tool of state governance tout court. And yet for many District Medical Officers, who were already in some sense employed by the state, the idea of a comprehensive, regulated, and centralized system of state medicine was highly appealing in that the bureaucratic structures of public service provided them with their likeliest source of political and social authority, both as doctors and as men.Footnote 52 The Revered J. B. Owen spoke for many such individuals when, at a meeting of the Wolverhampton Health of Towns Association in 1848, he argued that “the medicine-man must henceforth be an officer of Government, endowed with rank, and commissioned with power … and if we decorate with medals, and recompense with pensions, our naval and military and other servants of the State … let not the men who daily encounter perils not a whit less fatal than those which battle brings into the field or fleet be any longer excluded from the well-earned gratitude of the nation.”Footnote 53

Owen's speech hints at the degree to which images of heroic masculinity developed within the medical press reached out into the wider public realm. In 1847, The Times carried an article on the “heroism of the clergy and medical men” in the face of typhus, while in the same year an anonymous contributor to the Lancet claimed that the deaths of so many District Medical Officers had extended “sympathy … beyond the pale of their own profession.”Footnote 54

Even more suggestive, perhaps, is the reception of medical heroism within the contemporary literary imagination, particularly in the work of Charles Dickens. Dickens entertained a profound interest in sanitary reform and was friends with a number of medical practitioners, including Thomas Southwood Smith.Footnote 55 His receptivity to the claims of medical rhetoric is best exemplified by the character of Allan Woodcourt in Bleak House, published serially between March 1852 and September 1853. Woodcourt is a kind-hearted “sea-going doctor” whose concern for the poor is evident in his attempts to save Jo, the young crossing sweeper, from the oppression of disease, want, and suspicion and whose moral integrity is confirmed by his marriage to the novel's principal protagonist and narrator, Esther Summerson.Footnote 56 In one particularly notable passage, Dickens depicts a conversation between Esther and the eccentric Miss Flite. Having recovered from a near-fatal case of smallpox, Esther is informed by Miss Flite that her beloved Woodcourt has been involved in a shipwreck in the “East-Indian seas.” Having allayed her fears as to Woodcourt's safety, she then proceeds to recount the details of that “awful scene”: “There, and through it all, my dear physician was a hero. Calm and brave, through everything. Saved many lives … took the lead; showed them what to do, governed them, tended the sick, buried the dead, and brought the poor survivors safely off at last! My dear, the poor emaciated creatures all but worshipped him. They fell down at his feet, when they got to the land, and blessed him. The whole country rings with it.”Footnote 57 Once again, however, Woodcourt's story only serves to highlight the relative neglect of medical heroism. Thus, when Miss Flite states that “my brave physician ought to have a Title bestowed upon him. And no doubt he will. You are of that opinion?” Esther replies, “That he well deserved one, yes. That he would ever have one, no”: “I said it was not the custom in England to confer titles on men distinguished by peaceful services, however good and great; unless occasionally, when they consisted of the accumulation of some very large amount of money.”Footnote 58

As Lauren Goodlad's reading of Bleak House suggests, this passage, and the character of Woodcourt more generally, embodies many of the tensions and ambiguities inherent in contemporary medical rhetoric and in understandings of the relationship between professionalism and the state. Woodcourt's actions may be heroic, even manly, but they do not conform to a conventionally militaristic model. On the contrary, Esther explicitly refers to them as “peaceful services.” Thus, while Woodcourt accords with the type personified by Sidney Bernard or Dr. Cunningham, his identity hovers awkwardly between a militaristic ideal of intrepidity and action and the domestic virtues of compassion and humanity. This tension between militarism and domesticity also reflects a broader tension in Dickens's work between what Goodlad identifies as a liberalist pastorship and a more utilitarian statism. At the heart of Dickens's narrative is a critique of what The Times would soon refer to as the “system,” a social and governmental apparatus in which those with wealth and connections thrived, while men of industry and ability did not. This contrast between the activity of men such as Woodcourt and the idleness and insularity of aristocratic parliamentary politics is brought into even greater relief by the ironic use of the shipwreck as a metaphor to describe the state of the country in a conversation between Lord Boodle; William Buffy, MP; and Sir Leicester Dedlock.Footnote 59 In this sense, Dickens's text paralleled a reformist medical rhetoric that purposefully conflated individual acts of heroism with the more general claims of lower-status medical practitioners to state recognition, reward, and authority. And yet in many ways, Woodcourt does not conform to the model of disinterested professional expertise advanced by medical radicals and personified by his friend Southwood Smith. Goodlad notes, for example, the geographic and conceptual distance between Woodcourt's actions and the more immediate concerns of sanitary reform. She claims that “Dickens neither installs Woodcourt in the civil service or military, nor depicts him as citizen-advocate for local or voluntary sanitary improvements.”Footnote 60 Thus, while Dickens clearly recognizes the complaints of medical practitioners concerning their lack of recognition and the inefficiency of governmental authority, he falls short of advocating a form of state service akin to the military. Dickens's hero (for Woodcourt is nonetheless a hero) is no dispassionate agent of state power; he is, instead, a compassionate agent of pastoral care.

^II. Crimean Complexities

This complex and occasionally ambivalent fusing of the medical and the military was to play an especially important role in the shaping of medical masculinities during and immediately after the Crimean war (1854–56). Although one commentator has claimed that the Crimea represented “a watershed in civil-military relations” that would propel the army to the forefront of Victorian popular consciousness, others have shown how it was marked by an antiaristocratic critique of military incompetence, fueled by the reporting of William Howard Russell in The Times, and sustained by the Administrative Reform Association (of which Dickens was an active member).Footnote 61 It is only possible to reconcile these two apparently contradictory perspectives by considering the wider cultural significance of the Crimean war. It certainly did provoke a debate about the values and abilities of the aristocracy versus those of the middle and commercial classes that, conjoined with the ostensibly meritocratic recommendations made by the Northcote-Trevelyan Report on the Civil Service (1853–54), constituted perhaps the greatest challenge to aristocratic hegemony in Victorian Britain.Footnote 62 And yet the very absence of appropriately heroic figures among the political and military leadership served in many ways to raise the popular profile of the army as the public came to valorize the bravery and fortitude of the common soldier. If the Crimea was, to quote The Times, a “people's war,” then it was also very much a soldiers’ war.Footnote 63 From the “Thin Red Line” of Balaclava to the “Soldier's Battle” of Inkerman, it was subalterns, noncommissioned officers, and private soldiers who were generally credited with snatching victory from the jaws of defeat, a “democratization” of heroism that was most clearly expressed by the inauguration of the Victoria Cross (1856) as an award for valor, regardless of rank.Footnote 64

Similar currents also served to shape the cultural representation of medicine during the war. Although health care provision in the East was manifestly inadequate and the Army Medical Department one of the most heavily criticized of the war, the Crimea also produced a number of medical heroes whose individual acts of courage and self-sacrifice functioned as a synecdoche for the professionalism and ability of army medical personnel in the face of routine administrative incompetence. Today the best-known figure associated with medicine in the Crimea is undoubtedly Florence Nightingale. However, while Nightingale's reforms of the Scutari hospital were certainly well covered in the contemporary medical press, her subsequent fame has served to obscure a number of equally celebrated army surgeons whose heroism, unlike the maternal (or matriarchal) Nightingale, were more in keeping with established masculine conventions.Footnote 65 Around fifty-four such individuals lost their lives during the campaign, and three were subsequently awarded the Victoria Cross.Footnote 66

Perhaps the most famous of all was Dr. James Thomson, assistant surgeon in the 44th Regiment. Left behind for nearly five full days after the battle of the Alma to care for around 750 wounded Russians in the face of potential attack from Cossack units, Thomson saw the survivors onto the HMS Albion, only to die from cholera just over two weeks later.Footnote 67 Thomson's name resounded throughout the medical press. In October 1854, the Lancet asked: “But what is to be said of the heroism required to face death in the thousand forms in which it must have presented itself to the mind of that lonely man? … We answer that, let the deeds done by others in that gallant army be what they may, none are more worthy of mention, or required more heroic courage and self-devotion, than this of dr. thomson of the 44th.”Footnote 68

Such heroic imaginings extended beyond the medical sphere. Not only were Thomson's actions reported in more general accounts of military heroism, but two of Arabella and Louisa Shore's poems in their Crimean War Lyrics (1855) referred directly to the actions of medical men during the conflict.Footnote 69 One of these, “The Brave who have not Bled,” paid tribute to those who had died from disease, “Soldier and brave physician” alike, while “The Good Physician” celebrated the Thomson episode.Footnote 70 The opening stanza acknowledges the essential parity of military and medical heroism:

Although referring to the somewhat removed context of India, the heroism of military surgeons is likewise evident in William Makepeace Thackeray's contemporary novel The Newcomes (1854). Having made a commonplace joke at the expense of Danby Jilks, the family doctor, Colonel Thomas Newcome retracts it as being “too severe upon … the profession.” He then apologizes by “narrating many anecdotes he knows to the credit of surgeons. How, when the fever broke out on board the ship going to India, their surgeon devoted himself to the safety of the crew, and died himself, leaving directions for the treatment of the patients when he was gone! What heroism the doctors showed during the cholera in India; and what courage he had seen some of them exhibit in action.”Footnote 72

As I have suggested, however, the representation of medical heroism in the Crimea was not without its political edge. As with prewar examples, accounts of the Thomson episode, in both the medical and the popular press, were framed by grievance. Until the formation of the Royal Army Medical Corps in 1898, neither the medical officers under the command of the Army Medical Department nor the surgeons and assistant surgeons of individual regiments were accorded the status of military personnel but were technically civil officers. As such they were not entitled to the same conditions of service as their military colleagues; they held no substantive rank (and hence had no executive authority), were not entitled to servants or a pension, and were ineligible for military honors and awards.Footnote 73 The issue did not begin with the Crimea. In 1847, for example, the Lancet had complained that the award of medals to veterans of the Peninsula and naval campaigns during the French wars would not extend to medical men.Footnote 74 Nevertheless, the Crimean campaign heightened the intensity of the debate, especially since the Lancet's rhetorical contrast between the professionalism of the middle-class army surgeon and the elitism and incompetency of “Horse-Guards” took shape within the context of a much wider critique of aristocratic inefficiency. Delivering his oration to the Medical Society of London, John Fernandez Clarke asked: “Are the services conferred upon our armies by the medical officers attached to them of less importance to the welfare, or even to the success of the troops then those rendered by generals and lieutenants? … Braver and more skilful men are not to be found in any country. … If ever a monument should be raised for great actions upon the field of battle, that monument should be raised to Thompson [sic].” Referring to the equally heroic actions of “Mr Wilson,” an assistant surgeon who rallied the men of the Duke of Cambridge's division at the battle of Inkerman, Clarke pointed out that his only reward had been promotion to surgeon, claiming that “in ancient Rome, the civic crown would have been placed upon his brow; in France, he would have been decorated with the star of the Legion of Honour.”Footnote 75 Once again, then, French “meritocracy” provided a counterpoint to British governmental and military neglect, as commentators repeatedly referred to Napoleon's high estimation of military surgery and highlighted the fact that medals and other honors had been freely awarded to the medical personnel of the French army in the Crimea.Footnote 76

And yet, while the anomalous status of military surgeons was clearly an object of great vexation for many medical commentators, the fact that Thomson and his ilk were, in effect, civil practitioners, merely served to strengthen the metaphorical and rhetorical associations between medical practice and militaristic heroism; if the grievances of the poor law surgeon and the military surgeon were essentially the same (lack of reward, recognition, and authority), then so too was their bravery, fortitude, and self-sacrifice. In an 1854 obituary, the Lancet therefore segued from the medical dimensions of the “Eastern Question” into those of the “Condition of England”: “All the true glories of the medical profession are unostentatious. They are founded on duties performed … in scenes of poverty and pestilence at home, and of wounds and pain … amongst our gallant soldiers and sailors abroad. … In civil life it is the same. The medical practitioner is the slave of all. … If some fierce epidemic rages, and his wealthier neighbours fly for safety, he remains to encounter every danger.”Footnote 77 Although such connections between military and civil medicine were most often deployed in relation to public health and the plight of the poor law surgeon, this obituary provides an insight into how even routine, domestic medical practice could be presented as a form of everyday heroism. After all, the practitioner being commemorated was neither a military surgeon nor a District Medical Officer but rather a seventy-one-year-old general practitioner from Market Rasen in Lincolnshire. Thus, interpolated between the established imagery of medical heroism were scenes of a more prosaic nature: “His meals, his rest, all his social comforts, are perpetually interrupted. In country practice, especially, he endures fatigue, encounters darkness and storm, is sent for at all hours on every capricious impulse of the rich. … His life is a continued struggle, and if he is enabled to bring up and educate a family of children, and to die solvent, he is looked upon as a favorable exception.”Footnote 78

Again, such associations were also evident in the wider cultural sphere. Stefanie Markovits's work considers the relatively oblique ways in which the Crimean war shaped the Victorian literary imagination. As she shows, aside from Charles Kingsley's Westward Ho! (1855), which was not, in any case, based on contemporary events, the 1850s and 1860s were remarkably free of “war novels.” Instead, much contemporary literature, most notably Elizabeth Gaskell's North and South (1854–55), engaged with the war in a tangential manner that foregrounded the domestic concerns of poverty, labor, and social relations.Footnote 79 What is even more remarkable about such literary productions, I would suggest, is the way in which medicine functioned as a point of contact between civil and military conceptions of heroism, the figure of the doctor serving as an alternative to more conventionally martial heroes. In 1868, for example, William Howard Russell published his one and only novel, The Adventures of Doctor Brady. Drawing on his firsthand experiences of the Crimean war and Indian “mutiny,” it elaborated a tale of sensational adventure and daring. And yet the main hero of the story, Terrence Brady, is not a soldier, as one might expect, but rather, as the title suggests, a doctor. In a similar vein is Charles Kingsley's Two Years Ago (1857). Unlike Westward Ho!, Two Years Ago was concerned with recent events, its title referring to a time when “pestilence was hovering over us and ours, while the battle-roar was ringing in our ears.”Footnote 80 The hero of the novel is Tom Thurnall, a manly and intrepid doctor who, after traveling the globe and surviving all manner of life-threatening situations, is shipwrecked off the Devon coast. Rescued by the beautiful and pious local schoolteacher, Grace Harvey, Tom remains in the village of Aberalva, which he proceeds to deliver from an outbreak of cholera before volunteering for service in the Crimea, where he is followed by the Nightingale-esque Grace. Kingsley's novel thus conflates the heroism of sanitary medicine with the heroism of military adventure. As Kristine Swenson has argued, the cholera outbreak in Aberalva “becomes a training ground and metaphorical equivalent for heroisms that characters will perform in the Crimea.”Footnote 81 This association between medical and military masculinities is further enhanced by Tom's friendship with the like-minded Major Campbell, while his active and intrepid character as a “man of action” is juxtaposed to the weak effeminacy of Elsley Vavasour, an aspirant “Spasmodic” poet.Footnote 82 In her reading, Swenson suggests that the book's “conflation of a cholera epidemic and the war would likely have seemed quite natural to a Victorian looking back upon 1854–5, for a cholera epidemic did, in fact, plague England in the summer months of 1854, just as in the novel.”Footnote 83 Perhaps, but such claims neglect some of the more subtle imaginative associations at play here. As Markovits notes, both Doctor Brady and Two Years Ago are complex works, characterized by rhetorical evasion and “generic discomfort.” In Doctor Brady in particular, there is a profound ambiguity in the protagonist's characterization, with Russell “repeatedly reminding [the reader] that Terrence would rather have been a soldier.”Footnote 84 It is almost as if Russell was unsure how exactly to represent a form of noncombatant heroic manliness. In this sense, both novels suggest that medicine provided an important imaginative resource for the construction of a midcentury middle-class masculinity that somehow married militaristic visions of heroism with a more domesticated cult of activity. At the same time, however, they also testify to the indeterminacies of medical professional identity, oscillating between the domestic and the warlike and yet never totally comfortable in either.

I opened my analysis by suggesting that medical discourses of militarism and heroic masculinity were tied to a wider reformist agenda that sought greater state reward, recognition, and authority, not simply for District Medical Officers but, more generally, for those lower-status general practitioners and provincial medical men who were excluded from the centers of corporate power. The question therefore remains as to how successful this harvesting of heroism's “symbolic capital” was in more explicitly political terms. Of course it is almost impossible, not to say historically naive, to establish a direct causal relationship between metaphor and rhetoric on the one hand and political and legislative developments on the other. Yet it is remarkable that the 1850s, the decade that saw the flowering of a discursive and representational culture of militarized medical masculinity, also witnessed the passage of perhaps the most important piece of legislation relating to the medical profession in nineteenth-century Britain, the 1858 Medical Act. As in the literary sphere, medical reformers used the experiences of the war to reflect on the conditions of metropolitan practice. Relating the findings of the 1856 Select Committee on the Medical Department of the Army to the concerns of his colleagues, for example, Richard Griffin of the Poor-Law Medical Reform Association claimed that “history teaches us that most of the calamities affecting nations arise from the first complaints of individuals being unheeded by those in authority. … The sufferings of our army in the Crimea are so fresh in our memory that it needs no other example. I pray you therefore no longer to disregard the complaints of your medical officers, in whom you have reposed a solemn trust—the care during sickness of no less than four millions of the labouring classes of this great kingdom.”Footnote 85 Medical reformers were at least moderately successful in pressing their case. Not only were the terms of poor law medical service generally improved during this period, but the Medical Act, with its establishment of the Medical Register and General Medical Council, granted the profession the state recognition and powers of effective self-governance that many had demanded.Footnote 86

The imaginative and political appeal of the military paradigm, therefore, ensured that it continued to play a prominent role in medical rhetoric throughout the later 1850s and 1860s. This was particularly true of the preliminary addresses given to first-year medical students. As pedagogical and rhetorical tools designed to initiate students into the values of the profession, such lectures provide an invaluable insight into contemporary medical culture. As well as looking back to the experience of the Crimea, medical lecturers elaborated new heroic figures, especially those who had been forged in the masculine sphere of conflict. One notable example was David Herbert Llewellyn, assistant surgeon on board the Confederate States Navy's commerce-raider Alabama. Having been engaged by the USS Kearsarge off the French coast, Llewellyn tended to the wounded and, when the order came to abandon ship, refused to go aboard the lifeboat until all of his patients had been evacuated. He drowned when the ship went down and was later awarded the Confederate Medal of Honor. Llewellyn was a Briton, born in Wiltshire and educated at Charing Cross Hospital medical school.Footnote 87 Such links between a medical school and the heroic actions of a former pupil held great imaginative appeal for new students. Thus, the students and staff of the Charing Cross school erected a granite tablet to Llewellyn (fig. 1), while St. Thomas's found its own hero in Edward Chaffers, who, “actuated by laudable motives, proceeded to the Southern States of America,” where he became acting chief surgeon of Hume's Cavalry Division.Footnote 88 But of course the resonance of such actions was not confined to the schools in which they had studied. Addressing the pupils of the Manchester Royal School of Medicine in 1864, for example, Mr. Stone cited Llewellyn's actions and those of the Crimean surgeons as testament to the fact that “benevolence, heroism, [and] duty formed the tricolour of the medical profession.”Footnote 89

As with the period before the Crimea, medical lecturers of the late 1850s and 1860s not only sought to use cases of individual heroism as exemplars of general medical character but also transposed the experience of war onto the profession as a whole through the imaginative amalgamation of civil and military practice. In addressing his pupils at the London Hospital, Dr. Barnes suggested that medicine was “one ceaseless battle to counteract the life-invading influences that men raise against each other.” In this sense he perpetuated the vision of medicine as a form of middle-class moral reform directed against both working-class culture and

Figure 1 —Memorial to David Herbert Llewellyn at Charing Cross Hospital, London (courtesy of Clare Hickman).

the inefficiency of aristocratic government. Referring to poor sanitation, industrial accidents, and alcohol abuse as “the evils we have to combat in civil life,” he stated that “from this scene, the mind follows the surgeon to the field of battle … [where] he has to avert or to quell the diseases that spring from ignorance and neglect, as well as to repair the injuries inflicted by the destructive engines of war.”Footnote 90 At its most fundamental, the militarization of medical culture entailed the repeated use of martial analogies to describe the relationship between medicine and illness. Languages of “combating,” “battling,” or “fighting” disease abounded in this period. For example, Dr. Anstie of the Westminster Hospital compared the “practical physician” to a “man who fights in the gloom of twilight with foes who seem innumerable,” while Dr. Braxton Hicks of Guy's employed an elaborate military analogy to describe changes in therapeutic practice: “In former times … disease was a great entity; inflammation a violent enemy who would to a certainty destroy us if we did not kill him, and the patient was made the neutral ground. … Now we rather look upon the patient as a beleaguered city: we throw in our supplies from time to time, leaving the garrison to fight it out, and as long as it is equal to the contest, we do not sap its supplies by adding to its numbers.”Footnote 91

To a great extent, such discourses were shaped by the wider cultures of a bellicose imperialism and nationalism that emerged in the wake of the Indian “mutiny” and that were enhanced by the French invasion scare and volunteer movement of 1859–60. Against such a backdrop, medical rhetoric could not but imbibe the languages and ideologies of an aggressive militarism. Thus, in a remarkable speech to the first-year medical students of the London Hospital in November 1859, George Critchett opened with an imaginative flourish, comparing such annual addresses to other historic gatherings in which the people combined “to carry out some great national cause or avert some great national calamity.” Critchett's allusion to the French menace would have been clear to his audience as he imagined “what a huge national assemblage there would be if the foot of the rash invader were ever to be placed on [our] free and sacred soil; how Britain would rush in her might, and be as one to arm, to repel and to crush.” Framed though it was by contemporary events, Critchett's warlike imagery was not simply a cheap sop to popular jingoism. Instead, it inflected the tone of his entire speech, as war, empire, and medicine were fused into a seamless vision of national service and self-sacrifice. Beginning with the field of sanitary medicine he claimed that “it is now universally admitted that our profession is carrying on a noble work. … Disease [is] combated and suffering allayed … pestilence is traced to its lurking places and the laws of health are explained and enforced. The important body of men who are toiling to accomplish all this are diminishing in number. … Going forth in the spirit of a missionary, they sometimes encounter the death of a martyr.” With the image of the missionary providing an imaginative link between the domestic and imperial contexts, Critchett then proceeded to represent war and empire as medicine's guiding mission: “It is an important and interesting day, when our country sends up fresh recruits to fill up the ranks of our profession, and to meet the increasing demands of our army, our navy, our merchants’ service, and of those vast and numerous colonies upon which it is said the sun never sets. It is this fresh infusion of young life, and vigour, and enthusiasm that from year to year renews and sustains our profession.”Footnote 92 For some commentators, therefore, the rise of imperialism and nationalism allowed them to reframe medicine as a form of quasi-military service. For others, however, the relationships among medicine, war, and empire, never exactly straightforward, were rendered even more ambivalent and complex by this turn of events.

I have already suggested that medical invocations of a militarized masculinity often served to highlight the discrepancy between a popular estimation of medical sacrifice and that of military glory. I have also suggested that they embodied an essential tension between the humanitarian and domestic values of care and the military values of conquest and destruction. From the late 1850s onward, these tensions came increasingly to the fore, shaping a distinct and alternative strand

Figure 2 —Memorial to the medical practitioners of the Crimean war at Victoria Hospital, Netley, Hampshire. Line engraving by E. Albutt after J. C. Armytage (Wellcome Library, London).

within medical discourse to sit alongside the warlike imaginings of men like Critchett.

Many medical practitioners were frustrated by what they saw as the continued neglect of medical service and the ambiguous position of noncombatant heroism in a society increasingly obsessed with martial values. Even in the military sphere, the Crimean war had done little to improve the status of army surgeons. In 1864, a monument to the medical practitioners who had served and died in the Crimea was unveiled at the new military hospital at Netley, near Southampton (fig. 2).Footnote 93 The London Review noted that the monument had “been somewhat long in coming,” hoping that it would “make reparation to the medical profession for the stupid contempt with which combatant officers in the army, much to their own discredit, affect to non-combatants.”Footnote 94 But as it acknowledged, this gesture belied the fact that medicine still occupied a markedly inferior position within the military, so much so in fact that many vacancies in the Army Medical Department and Naval and Indian Medical Services remained unfilled. “Can we wonder at such results,” it asked, “when both in the army and the navy gentlemen of education, naturally proud of their noble profession, find themselves treated as inferiors?”Footnote 95

The same was true of civil medicine. Despite the apparent successes of poor law medical reform and the Medical Act, many practitioners remained deeply unsatisfied, perceiving the act's provisions to be compromised and the state's recognition of medicine grudging and halfhearted. One especial grievance was that, while the act may have recognized the parameters of “orthodox” medicine in the form of the Medical Register, it did nothing whatsoever to protect the profession (and, they would claim, the public) from the depredations of “unlicensed” and “incompetent” practitioners.Footnote 96 Thus, rather than enhancing the prestige of medicine, this “martial vision” only served to highlight how little it had gained by comparison. What had always been a fragile imaginative association had now, for some at least, become untenable. In commenting on the limitations of the Medical Act, one correspondent to the Lancet stated that “we English are, doubtless, a fine people in most things. … First in arms … and in commerce, the glorious symbol of our liberty and strength floats on every ocean, and waves in every breeze of the wide world.” However, “when we look nearer to home, we find a worm at the very pith of this magnificent tree; and, as regards the protection of human life from the ravages of quackery and imposture, the dismal banner of the death’s-head and cross-bones would best symbolize the … care of the State.”Footnote 97

In some cases, this discontent and frustration served to shape a novel humanitarian discourse in which commentators posited medicine in contradistinction to the military endeavor, asserting the moral supremacy of their own profession. Such discourses crystallized in the debates that surrounded the erection of a statue to Edward Jenner in Trafalgar Square. During the middle decades of the nineteenth century, the square had become the premier metropolitan space for the commemoration of British military and imperial glory.Footnote 98 Nelson's Column had been unveiled in 1843 and was followed by statues to Sir Charles Napier (1855) and Henry Havelock (1861).Footnote 99 The inauguration of the statue to Jenner in May 1858 was therefore opposed by many who thought its positioning inappropriate. In Parliament, the radical MP Thomas Duncombe asked whether the statue might be moved, claiming that although he “did not mean to say that a statue of Dr Jenner was not a very good thing in its proper place … he thought it was altogether out of place among statues of our naval and military heroes.” If the government would not move it, he hoped that “some independent Member would move an Address to the Crown for the removal of the statue of this promulgator of the cowpox-nonsense from its position in Trafalgar Square.”Footnote 100 Duncombe's opposition to compulsory vaccination (although not to vaccination per se) may well have informed his opposition, as may have his prior service in the army. Nevertheless, similar sentiments were expressed in a somewhat more sober tone in The Times. Referring to the existing statue of Napier and the planned statue of Havelock, the editor thought Jenner's positioning beside these “two great soldiers” a “ridiculous juxtaposition.” “The expense of removing this unfortunate statue of dr jenner to some more suitable position,” The Times concluded, “can only be very trifling, and we earnestly trust that the public authorities will not insult the commonest feelings of taste and propriety by leaving it where it is now placed.”Footnote 101

Needless to say, many medical practitioners were outraged by such statements, not least because Jenner embodied much of what they held dear concerning medicine's contribution to the “public good.” The British Medical Journal wondered whether foreign subscribers to the Jenner monument would “sneer at the civilization of these islanders, who think the statue of a Napier is polluted by such company—who scornfully think that a hero who triumphed over a loathsome disease is not worthy to sit at the feet of the hero of the Scinde.” “We see no reason whatever,” it asserted, “that the finest site in Europe should be appropriated to the effigies of soldiers only. Why should those who destroy be ever placed in the front rank, whilst the philanthropist and the philosopher are only permitted to occupy out-of-the-way corners in forgotten squares.”Footnote 102 Similarly, in his speech to the Bristol and Bath branch of the British Medical Association, James George Davey told his audience that, on a recent trip to London, he had “strolled through Trafalgar Square” and, gazing on the statues there, had asked himself what future generations would think of Jenner “side by side with Nelson and Napier—the medical philosopher and public benefactor, side by side with fighting men—with the heroes of Trafalgar and the Scinde. … Is not the one for all time—the others named but for a period? The name of Jenner will, in the long time yet to come, be associated with a sound and progressive civilization; the names of Nelson and Napier, with but blood and rapine.”Footnote 103

^III. From Internationalism to New Imperialism

By the late 1850s and 1860s, then, the military paradigm occupied a deeply ambiguous place within medical discourse. On the one hand, comparisons with the army figured medicine as an equivalent form of national service and underwrote a reformist agenda for the state recognition and regulation of medical practice that achieved at least partial success with the passage of the 1858 Medical Act. On the other hand, the cultural ascendancy of the military in mid-nineteenth-century Britain also served to open up an imaginative gulf between medicine and war, with some practitioners articulating a humanitarian discourse in which the heroism of medicine did not so much mirror that of combat as occupy a superior moral plane to it. In this final epilogic section, I want to trace these tensions through to the end of the century, sketching, in a necessarily brief and speculative manner, the ways in which these cultures of medical identity—the one overtly masculine, the other more domestic and feminine—played out against the backdrop of wider political circumstance.

If, as is generally accepted, the 1850s witnessed the beginnings of a popular militarism in Britain, then it should be remembered that attitudes toward war were also tempered by events at an international level. As John MacKenzie has suggested, one of the factors that promoted positive attitudes toward the army was the fact that, after the Crimea, most of the conflicts in which Britain engaged were small colonial wars against relatively technologically unsophisticated opponents. Not only did this present “the image of war, without its guilt and only five-and-twenty per cent of the danger,” but in the wake of the Indian “mutiny,” it also sustained a vision of military conquest and subjugation as a moral endeavor, an exercise in the dissemination of civilization and “international law.”Footnote 104 And yet if colonial conflict was celebrated within contemporary journalism, music, and juvenile literature, war between western powers occupied a rather different psychological and imaginative space.Footnote 105 The battle of Solferino (1859) and the American civil war (1861–65) had demonstrated the horrendously destructive potential of conflict between equivalent belligerents, casting it in a different moral light to that between imperial armies and their colonial enemies. Alongside the celebratory rhetoric of medicine and empire that characterized addresses to medical students, the later 1860s and 1870s therefore witnessed the development of that discourse in which the humanitarianism of medicine was situated in direct opposition to the horrors of modern warfare.

This development undoubtedly owed much to the fact that medicine itself took a leading role in international efforts to mitigate the effects of conflict. In 1863 Henry Dunant and Gustave Moynier founded what would become the International Committee of the Red Cross, the coordinating body for a network of voluntary organizations providing supplementary medical assistance in times of war. In the following year, the representatives of fourteen European countries signed the Geneva Convention, guaranteeing the neutrality of wounded soldiers and medical personnel. During the Franco-Prussian war (1870–71), numerous British medical practitioners attached themselves either to the medical services of the French or “German” military or to volunteer organizations. However, whereas in the American civil war men such as David Llewellyn and Edward Chaffers had served as cobelligerents, Llewellyn going down with his ship and Chaffers sporting a “scar in the face made by a Federal sabre at Shelbyville,” those who volunteered in the Franco-Prussian conflict, distinguished by their Red Cross brassards, did so in a neutral capacity, treating the wounded of both nations and regularly crossing between the contending sides.Footnote 106

Combined with an increased internationalism in medical research and practice, the foundation of the Red Cross, the signing of the Geneva Convention, and the experience of the Franco-Prussian war therefore appeared to presage a new era of international humanitarianism that placed medicine legally, morally, and imaginatively above the militaristic concerns of nationalism and imperialism.Footnote 107 During the 1870s, the British medical press often contrasted medicine's humanitarian mission with the brutality of war. This was particularly true of the Russo-Turkish conflict (1877–78), in which tales of the “Bulgarian Horrors” provoked popular outrage and provided a political platform for William Gladstone's moralistic and internationalist liberalism.Footnote 108 As Patrick Joyce has argued, Gladstone's rhetoric placed women at the heart of the body politic. Their “warmth and softness,” he suggests, allowed Gladstone to transcend the abstractedly political and to address an essential humanity “bound by a love women had a peculiar knowledge of, and overseen by God in his providential wisdom.”Footnote 109 The parallel development of the Red Cross can be said to have embodied a similarly domesticated and feminized vision of medicine, in which compassion and mercy stood opposed to violence and destruction.

In reality, however, this moment of international humanitarianism seems to have been relatively short-lived. For all his criticisms of Benjamin Disraeli's aggressive foreign policy, Gladstone's moderate and militarily temperate administration collapsed in 1885 amid the fiasco surrounding the death of General Gordon at Khartoum. Moreover, despite the policy of “Splendid Isolation,” Britain's dealings in Africa contributed to rising tensions and military rivalries between the European powers. The neutrality of medicine was likewise to prove illusory. As both John Hutchinson and Bertrand Taithe have argued, rather than situating medicine above war, the formation of voluntary relief organizations actually served to harness medicine to a nationalistic project by allowing states to mobilize civilian and humanitarian resources in pursuit of strategic aims.Footnote 110

By the turn of the century, therefore, an aggressive militarism once again seems to have permeated medical discourse. Nowhere was this more evident than in the coverage of the South African War (1899–1902) by the medical press. As in the Crimea, the Lancet paid regular tribute to the heroism of military medical personnel, suggesting that “never have medical officers shown greater courage and more self-sacrificing devotion to duty under trying circumstances in the battle-field than have the soldier surgeons of the queen on the present occasion.”Footnote 111 In the field of visual representation, too, images of the Royal Army Medical Corps and the Red Cross in South Africa frequently emphasized the bravery and daring of medical practitioners under fire, resounding in a pictorial language of “Boys’ Own” masculinity (fig. 3).

Figure 3 —“A Non-combatant Hero—an Army Doctor at Work in the Firing Line” (Wellcome Library, London).

Despite the apparent similarities with the Crimea, medical discourse around the South African War differed in a subtle yet highly significant way from that of the early Victorian period. Whereas mid-nineteenth-century medical reformers had employed the trope of militarism rhetorically, to buttress claims of public service and demand greater support from the state, their late Victorian and early Edwardian successors perceived a much more intimate relationship between medicine, war, and masculinity. Speaking to the Reform Club on his return from South Africa, the surgeon Sir William MacCormac “held that the war was one of the best things that could have happened to England, because it brought out the manhood of the national character and displayed our brave bearing in evil circumstances to other nations.”Footnote 112 In reality, however, the war had given rise to profound concerns about the nation's “manhood” and about the physical and moral capacities of the British soldier. In the ensuing debate about “national efficiency” and the “national physique,” medicine sought to play a prominent role in preparing the country for war.Footnote 113 The Lancet, for example, was an energetic advocate of compulsory military training: “It not only seems to us right that there should be some system of obligatory military training on the part of the youth and young manhood of this country but from a medical standpoint we hold that it would prove highly beneficial. The effect of a military training … is to strengthen the character and manliness of a people.”Footnote 114 In the field of public health, too, a moralistic, even domestic, concern to redeem the poor from squalor had given way to a eugenic and avowedly militaristic desire to ensure a healthy “stock” for national and imperial defense. As H. Beale Collins told his audience at the Home Counties Branch of the Society of Medical Officers of Health in April 1904, “The foundations of empire rest on the individual, and the permanence of an empire remains assured whilst every individual is physically and morally sound. … Unfortunately, the improvident are so hampered by heredity, environment, and lack of opportunity, that those of their children who survive infancy and reach adult age are physically of little use for imperial purposes.”Footnote 115

By taking my analysis up to the beginning of the twentieth century, it is clear that, despite an apparent continuity, a profoundly significant transformation had taken place in medical culture. For Edwardian practitioners in the decade or so before the First World War, the relationship between medicine and war had transcended the level of rhetoric and metaphor. In the debates surrounding the degeneration of the British population and the quest for national efficiency, medicine had itself become a major driving force behind the militarization of British society.

^IV. Conclusion

One of the purposes of this article has been to show how particularly resonant visions of masculinity might be transposed, as metaphor and ideology, across social groups and fields of practice. In analyzing the rhetorical use by medical practitioners of the tropes of militarism and heroic masculinity throughout the Victorian period, I have demonstrated both the potentials and the limitations of that endeavor. Medical practitioners, especially those employed in the state service of the poor law or in the sphere of public health, certainly did liken themselves to soldiers, fighting and dying in the face of disease. Although it was a language of comparison, which sought to appropriate the “symbolic capital” of martial heroism and intrepid masculinity, it was also very much one of contrast. The courage, devotion, and self-sacrifice of the middle-class general practitioner and District Medical Officer were shaped in opposition to the complacency, ease, and self-interestedness of the medical “aristocracy,” just as the bravery and fortitude of the army surgeon were counterposed to the incompetence and inefficiency of the military hierarchy. Likewise, the popular appreciation and governmental reward of military valor were contrasted with the neglect of sanitary medicine, as medical reformers sought to represent their work in tending to the health of the laboring population as a form of state service equivalent in importance to national defense or imperial conquest. And yet despite some evident success, not only in terms of legislation and administrative reform but also, as is clear from contemporary literature, in the public imagination too, the refractive qualities of this discourse tended to dissipate some of its rhetorical force, creating tensions and ambiguities that always threatened to undermine it. Thus it was that while some practitioners sought to capitalize on the imaginative appeal of war and empire to shape the cultures and values of medicine, others, perceiving the army's popular ascendancy to come at some expense to themselves, articulated alternative discourses in which the humanitarian mission of medicine was presented as morally and politically superior to the baser qualities of martial valor.

Perhaps these ambiguities and contradictions should come as little surprise. Indeed, and as my brief discussion of post-Crimean literature suggests, the cultures of mid- to late nineteenth-century medicine might help shed light on the complexities of middle-class masculinity more generally. If, as Stearns, Dawson, and others have argued, the image of the “solider hero” really did come to dominate Victorian imaginings and performances of manhood, then the uncertainties of medical discourse demonstrate the difficulties in transposing such models into the civil sphere. How exactly was the model of the “solider hero” enacted outside of the army and in the comparatively placid regions of domestic life? If the experience of medicine is anything to go by, the answer might well be obliquely and inconsistently. After all, despite Myerly's claims of a “martial vision” and the undoubted prominence of war within popular entertainment and fantasy, Britain was never a truly military state, neither politically nor culturally, not even in the years after the South African War. Compared to contemporary Germany, where, as Max Weber observed, the military provided the exemplary model for social and professional organization, the British tended to keep the army at something of an imaginative distance, and it never played a direct role in domestic political life.Footnote 116 In examining the ways in which Victorian medical practitioners engaged with the military paradigm, one can therefore see traces of a much wider cultural dynamic, namely, the ambivalent place of war in a liberal society.