Skip to main content

Disease, War, and the Imperial State

The Welfare of the British Armed Forces during the Seven Years’ War

The Seven Years’ War, often called the first global war, spanned North America, the West Indies, Europe, and India.  In these locations diseases such as scurvy, smallpox, and yellow fever killed far more than combat did, stretching the resources of European states.

In Disease, War, and the Imperial State, Erica Charters demonstrates how disease played a vital role in shaping strategy and campaigning, British state policy, and imperial relations during the Seven Years’ War. Military medicine was a crucial component of the British war effort; it was central to both eighteenth-century scientific innovation and the moral authority of the British state. Looking beyond the traditional focus of the British state as a fiscal war-making machine, Charters uncovers an imperial state conspicuously attending to the welfare of its armed forces, investing in medical research, and responding to local public opinion.  Charters shows military medicine to be a credible scientific endeavor that was similarly responsive to local conditions and demands.

Disease, War, and the Imperial State is an engaging study of early modern warfare and statecraft, one focused on the endless and laborious task of managing manpower in the face of virulent disease in the field, political opposition at home, and the clamor of public opinion in both Britain and its colonies.

296 pages | 3 halftones, 1 map, 1 table | 6 x 9 | © 2014

History: European History, Military History

History of Science


“In the eighteenth century by far the deadliest enemies of common soldiers and sailors were diseases such as scurvy, smallpox, or yellow fever.  Charters’s new book is the first to show in any detail the degree to which British authorities struggled to secure the health and welfare of the army and navy in the several theaters of combat of the Seven Years’ War.  Impressively researched in the British sources, clearly written, prudent in its judgments, and startling in some of its findings, this book will be important for all scholars of war, disease, and health.”

J. R. McNeill, author of Mosquito Empires

“Charters combines several key, heretofore separate strands in the history of the British empire.  In this cogent, readable, and thoroughly researched account we find discipline, racism, the Enlightenment, notions of climate and the body, military theory, emergent experimental science, governmental bureaucratic intervention, and the very nature of empire all brought to light within the lens of a key moment in the expansion of British power: the Seven Years’ War.  Highly recommended.”

Wayne E. Lee | University of North Carolina

“This is an important and much-needed account of how warfare affected the development of medicine and science in the eighteenth century. The modern state was supposed to care for its people, evidenced not least in how it cared for far-flung sick and wounded soldiers and sailors, while efforts to prevent disease also helped to create the enterprise later called public health. Charters therefore puts questions of the culture of power back at the center of Enlightenment medicine.”

Harold J. Cook | Brown University

“Charters places medical history closer toward the center of history, which it has long deserved. . . . Charters’s research is solid, and her arguments about the state are interesting and convincing. This book will be valuable to scholars interested in the empire, the growth of the modern British state, and the evolution of medicine. In fact, it is hard not to make inferences about some of the contemporary debates about the role of government from it. An important contribution in a number of ways, it should be read beyond the scholarly community. Essential.”


“Reading Disease, War, and the Imperial State will reward several audiences. Students of medical science will appreciate its insights into a relatively unexplored and poorly understood period of its history. Military historians will value its elucidation of the effects of disease control (or the lack of it) on the outcome of military operations in the Seven Years War. Political scientists will learn much from its account of the consequences of disease for military-civilian relations and early government-sponsored medical research and healthcare reforms. All in all, Charters has conclusively proven that the foundations of effective military medicine were laid in the eighteenth century.”

Michigan War Studies Review

Disease, War and the Imperial State does an excellent job of arguing for the importance of welfare and medical care in the prosecution, experience, and representation of the Seven Years’ War. . . This is an eminently readable and accessible piece of scholarship which makes a vital contribution to our understanding of military medicine in the eighteenth century.”

American Historical Review

“Charters’s most profound, if not overarching, argument is that the British state’s strength and success was predicated upon ‘its ability to portray itself as a credible and just imperial authority’ by addressing the public demand for the welfare of its armed forces. . . . She gathers her fascinating, diverse, and rich British-based research in order to examine it under the assumption that the British state’s use of contemporary medicine was a sign of the state’s concern for welfare. . . . Her argument is convincing: eighteenth-century warfare was an important cog in the process of state formation and its global scale in the Seven Years’ War demonstrates the complex task of managing manpower under siege by virulent disease, driven by public opinion, and complicated by political opposition.”

Journal of British Studies

“Charters’s research offers new and refreshingly provocative insights into a number of the most famous battles of the war. Her book offers a corrective to triumphalist histories of the conflict and the inevitability of British victory. . . . Disease, War, and the Imperial State is a significant addition to the literature on the Seven Years War. On one level, through its ambitious global scope, it reminds us of the worldwide reach and implications of the conflict. But it also has consequences for our interpretation of the eighteenth-century British state. Often regarded as the archetypal fiscal-military state, Charters asks us to consider how far it was also a caring state. And her work reminds us that the innovations developed to keep troops healthy in the middle of the eighteenth century were vital for later manifestations of the British Empire.”

Canadian Journal of History

“In this study of mid-eighteenth century warfare, Charters provides a cogent and engrossing overview of the role that disease played in the British Empire’s Seven Years’ War. Rather than the war’s conduct, it is the context (the disease variable) that is the book’s central focus. Informed by the deft combination of multi-archival sources and secondary synthesis, it does not seek a comprehensive study of medicine and medicinal practices, but rather tries to place the role of military medicine within the realm of the fiscal-military state thesis as a positive prop.”

Journal of Military History

Disease, War, and the Imperial State offers a new view of the human cost of eighteenth-century warfare. It leaves little question that disease resonated within the public sphere as being connected to a host of other wider concerns. . . . It makes the compelling case that, in medicine as in so many other areas, the eighteenth century was a turning point in the solidification of modern understandings of the world and that war was a crucial component of that process.”

Journal of the History of Medicine and Allied Sciences

“Historians of medicine will be particularly interested in Charters’s judicious treatment of procedures and processes developed to halt the spread of disease, and how these measures contributed to the growth of medical expertise and the transformation of medicine in Britain. . . . Disease, War and the Imperial State is wide-ranging in its treatment of a global phenomenon and deserves the broadest readership from historians of eighteenth-century Britain and its imperium, military and naval historians, and historians of medicine. . . . This book represents a major contribution to what we know about the consequences of war, war-related disease and organized efforts to heal and care for the sharp edge of Britain’s ambitious and caring imperial state.”

Social History of Medicine

“Charters, a rising scholar who teaches medical history at Oxford, has provided the first book-length study to focus on the medical aspect of any of the four major wars that Britain engaged in between 1701 and 1783. . . As is characteristic of her growing body of published work, Charters exhibits fine scholarship. She synthesizes well the secondary literature that relates to her project. Nevertheless, her sources are predominantly archival, and she also makes use of the wealth of published treatises by medical officers of the period, some of whom served in the Seven Years’ War. . . . While Disease, War, and the Imperial State is a fairly brief book, it reads big, in that it covers, and covers well, so much.”

Bulletin of the History of Medicine

“Charters’s ambitious and engaging book explores the British response to disease during the Seven Years’ War. The book is, on the one hand, a study in the creation of modern medical expertise, informed by a rich exchange between on-the-ground surgeons and physicians, medical theorists, military officials, and statesmen. On the other hand, the book argues that the war played an important role in state formation.”

Journal of American History

Table of Contents

List of Illustrations
List of Abbreviations


1. Wilderness Warfare, American Provincials, and Disease in North America
2. The Black Vomit and the Provincial Press: The Campaigns in the West Indies
3. Flux, Fever, and Politics: The European Theater of War
4. The Royal Navy’s Western Squadron: Trials, Innovation, and Medical Efficacy
5. Adaptation and Hot Climates: Fighting in India
6. Imperial War at Home: The Welfare of French Prisoners of War



Society for Army Historical Research: Award for Best First Book

American Association for the History of Medicine: George Rosen Prize

Be the first to know

Get the latest updates on new releases, special offers, and media highlights when you subscribe to our email lists!

Sign up here for updates about the Press