The Philosophy of Marriage in Its Social, Moral, and Physical Relations (1837) bore all the trappings of respectability. As its title page declares, its author, Michael Ryan, was a member of the Royal Colleges of Physicians and Surgeons in London and an attendant at the Metropolitan Free Hospital. Unlike the other Marriages that we have seen in this book, Ryan’s Marriage was issued by a medical and scientific publisher, John Churchill. At six shillings, it was more expensive than the other Marriages, and its smart blue cover would not have looked out of place on a middle-class bookshelf. Yet, the genesis of Ryan’s Marriage was not unlike the others. Addressing practically everything to do with reproduction, from the processes of botanical fertilization to the benefits of polygamy, much of its text was taken from articles Ryan had written for the London Medical and Surgical Journal. Ryan derived most of the text of those articles from lectures that he delivered at various medical schools in the metropolis. The lectures were, as one of his students remembered with a mixture of fondness and exasperation, “totally deficient in originality.”Footnote ¹ Ryan cobbled them together by copying lengthy passages from the works of other authors, which he gradually transported up the publication chain from lecture to article and article to book. Like William Dugdale and Joseph Lambert, Michael Ryan gathered, arranged, and reframed.

Ryan’s Marriage had another thing in common with the other Marriages: many medical men did not consider it a respectable publication. It was certainly a commercial success. At least seven editions of Ryan’s Marriage were issued in Britain and the United States through the mid-nineteenth century, and the work was renovated, as in Dugdale’s Marriage, and excerpted, as in Lambert’s Manhood, countless times. However, it was panned in medical journals for “pander[ing] to the tastes of that portion of the public, to whom the supposed mysteries, which Ryan unveils, are matters of curiosity.”Footnote ² “It is melancholy,” a writer for the British and Foreign Medical Review lamented, “to see a physician and a man of information descend, from whatever reason, to cater such kind of reading for the ill-regulated minds of all who may choose to indulge it; offending the eye of delicacy, like a quack-doctor on the wall.”

“Dr. Ryan,” this writer concluded, “has lamentably forgotten what is due to the public, to the profession, and to himself.”Footnote ⁴

The issue that Ryan’s colleagues had with his Marriage was not simply that he had written a work that seemed to invite prurient engagement. George Spratt’s Obstetric Tables (1833), published by Churchill four years earlier, could have been accused of the same thing. Obstetric Tables invited readers to explore the female body by manipulating mobile illustrations that would not have been out of place in an album of pornographic images. With the flick of a finger, a reader could reach between a lithographed woman’s parted legs and open her labia majora “like doors,” revealing a full-colour rendering of her clitoris, labia minora, and vaginal opening.Footnote ⁵ Yet, Obstetric Tables was lauded in the medical press as a marvellous pedagogical instrument. Nor was the problem solely that Ryan wrote for readers who were not medical experts. Publishers like Churchill advertised many works on sexual matters in the non-medical press. Such works were often read by, and sometimes written for, audiences beyond the medical, and most aroused no objections of this kind from medical practitioners or the public. Nor was Marriage’s derivative nature the main issue. Many medical men scoffed at consulting surgeons’ traffic in “stereotyped” knowledge, and some of Ryan’s colleagues were offended that he had borrowed their words without attribution.Footnote ⁶ However, compilation – even of the unattributed kind – was still widely practised in medicine, and generally accepted as a lesser mode of authorship.

The problem was that Ryan had done all of these things at once, and that he had done them so obviously, so artlessly. His purpose in “manufacturing” Marriage was clear in the eyes of his critics. He was not publishing to advance knowledge or to enlighten the ignorant. He was pandering to prurient curiosity to sell books, and promote his own expertise in the process. Medical journalists constantly alluded to Ryan’s allegedly unprofessional motives, as the British and Foreign Medical Review’s mock-pondering about his “objects” suggests. In July 1839, when Ryan appeared with the manuscript for a new book on another sexual subject, Prostitution in London, Churchill decided to end his partnership with Ryan, fearing for his own reputation as a medical publisher. “I find in reference to the strong feeling existing respecting your publications that I could not have come to any other determination,” Churchill wrote to Ryan. “I much regret that I should be compelled in any measure to break my connection with a gentleman from whom I have received kindness and derived profit.”Footnote ⁷ Michael Ryan was no Joseph Lambert. He had lectured in medical schools that, while not the best London had to offer, were respected. He had been the editor of the London Medical and Surgical Journal, which his colleagues recalled as a “beneficial influence on the Profession.”Footnote ⁸ He was a member of the Royal Colleges, and is now remembered as “a seminal figure in the development of medical jurisprudence.”Footnote ⁹ But what Ryan’s colleagues interpreted as his thirst for profit and publicity caught up with him.

Ryan’s predicament illustrates three issues that concern this chapter: overlaps in the ways pornographers, irregular practitioners, and regular practitioners treated medical knowledge in print; concern about those overlaps in medical circles; and the informal and contingent nature of the ways they were policed. To understand the evolving politics of selling sexual knowledge during this period, we need to understand that rapidly growing sectors of the print marketplace situated it into contexts that could be seen as dangerous to morals, to medical authority, and, in some cases, to medical incomes. However, we also need to understand the state of the regular medical profession and its fraught relationship with its own print culture. Medical practitioners had debated how to handle print since the Enlightenment. “Should medical knowledge be free and open? Or were there some occasions for secrecy?” they asked one another. “And assuming knowledge ought to be publicized, what were the proper channels? Was all medical knowledge fit for public consumption? … Was the publishing doctor a public benefactor? Or a self-serving self-publicist?”Footnote ¹⁰ These debates had not been resolved at the beginning of the Victorian period, and the chances that they would be resolved looked bleak. Medicine had become an increasingly competitive profession and was essentially at war with itself in the 1830s: left-wing advocates of radical medical reform, “general practitioners” unhappy with low incomes, conservative Oxbridge-educated physicians, and splinter groups within these groups had different visions for medicine and different ideas about what its print culture should look like.

Medical reformers recognized better than most print’s power to transform the profession and mediate public perceptions of it. From the 1820s, with the appearance of Thomas Wakley’s Lancet, they had begun to harness the medical journal as means of calling out corruption, fostering a sense of community among disparately identified medical practitioners, and galvanizing support for legislation to regulate medical practice.Footnote ¹¹ Their efforts seemed to be having the desired effect. The divisions that had marked medicine at the beginning of the 1830s began to close in the 1840s and 1850s, as medical men increasingly saw themselves, at least potentially, as part of a “unitary and democratized body of practitioners connected by common ideals, knowledges and practices.”Footnote ¹² Yet, print also threatened to undermine work to unite the medical profession, improve its reputation, and – crucially for medical reformers – “restructure the commercial status of medicine and its relation to the public.”Footnote ¹³ Part of the challenge lay in the fact that anyone could copy medical knowledge and use it for their own purposes. As this chapter shows, regular practitioners were especially worried about irregular publications and advertisements, which they thought undermined their credibility. However, neither would not have felt so threatening had the medical profession established a strong corporate identity and clear rules for maintaining it in print.

There were few agreed-upon conventions for publishing and promoting medical books. The overtly commercial style that Joseph Lambert took up and the suggestive ways in which William Dugdale framed medical knowledge were certainly considered beyond the pale. However, the boundaries between publishing for the public benefit, publishing to promote one’s services, and pandering to prurient readers were uncertain, and how far one could toe the lines between them without damaging one’s credibility or that of the profession at large was contested. In this context, medical debates about how publishing should be performed devolved into endless rounds of complaint, and print’s function as a means of making authority warped. Medical authority was not guaranteed to survive publication. The medical journal gradually came to offer one solution to these problems, and publishers like Churchill came to offer another.Footnote ¹⁴ Each offered a means of disciplining professional medical discourse and distinguishing it from other kinds. At this stage, though, what constituted orthodox medical practice was unsettled, the medical journal was young, and publishers like Churchill were still establishing themselves. Such publishers saw themselves as valuable assets to a divided profession that had no idea how to handle print communication. Their critics saw them as mercenaries whose economic interests threatened to compromise medicine’s integrity.

The Gentlemanly Monopoly

Victorian retrospectives of medical publishing often recall 1790 as the year of its birth. In that year, John Callow, a watchmaker’s apprentice, married a bookseller’s widow, whose shop at no. 10, Crown Court, London, stood near a famous anatomical theatre. On their marriage, the shop was a mess. Books overflowed from its shelves and stopped up its narrow corridors. Callow put the shop in order, and soon it became a favourite haunt of the practitioners who passed through the neighbourhood every day. Callow responded by increasing its stock of medical books. “In a few years,” the physician Samuel Merriman remembered, “it was recommended to Callow by Dr. John Pearson, the learned and scientific surgeon … to establish himself solely as a MEDICAL BOOKSELLER AND PUBLISHER.” Callow took the doctor’s advice. By the 1810s, his shop had become “the resort of professional men in search of information.” “Not only [were] the best old medical works to be found in Crown Court,” Merriman reminisced, “but also all the new publications connected with medicine,” many of which Callow now issued himself.Footnote ¹⁵

Publishers used a variety of strategies to establish a foothold in the market for medical books at the dawn of the Victorian period. Callow’s story was one of them. Promoted by John Churchill, who had bought Callow’s business in 1832, the legend furnished Churchill’s business with a legacy, one that connected it with London’s medical geography, its history, and some of the most famous medical men of the recent past. It downplayed the reputations for producing excellent medical works that general publishers like John Murray and Thomas Longman had developed in the previous century, and elevated a group of entrepreneurs, including Churchill, H. K. Lewis, J. W. Parker, Samuel Highley, Henry Renshaw, and Hippolyte Baillière, as heirs to a new model of medical publishing founded in a gentlemanly relationship between medics and bookmen.Footnote ¹⁶ This model was enabled by new commercial opportunities that the expansion of medical practice offered during the first half of the nineteenth century. However, its development was not quite as effortless as the story about Callow’s business implied. Publishers had to work hard to integrate themselves into the fabric of medical life.

Although a handful of men, including Callow, Renshaw, and Highley, called themselves medical booksellers and publishers during the first years of the nineteenth century, medical publishing really took off as a specialist niche of the British publishing industry in the 1830s and 1840s. As men like William Dugdale and Joseph Lambert seized the opportunities offered by expanding press and postal infrastructures to build thriving trades in cheap medical print, other publishers started or expanded medical lists aimed at readers with more money and education. These publishers were concentrated largely in London, Edinburgh, and Dublin, all well-known centres for publishing and medical training, where local doctors formed both a ready-made market for medical books and journals and a major source of manuscripts on medical subjects. As in most other areas of publishing, and despite the pre-eminence of Scottish medical training at the beginning of the nineteenth century, London was home to the largest of these publishers, and produced the most medical books and journals. However, London-based publishers frequently partnered with publishers in the other cities, who often created Irish and Scottish editions of London medical publications in addition to issuing their own.Footnote ¹⁷

The Strand, the geographic centre of London’s publishing and bookselling industry, offered would-be medical publishers an advantageous proximity to medical institutions. Parker’s shop at 445 Strand was neatly situated mid-way between the Royal College of Physicians and the Royal College of Surgeons, and down the street from the Lancet’s offices.Footnote ¹⁸ As Ruth Richardson has pointed out, this was a happy coincidence for Parker when the publisher – a generalist with a large literary list – began to expand his medical offerings in the mid-1840s. H. K. Lewis selected an even more advantageous position from which to publish and sell medical books when he set himself up in Gower Street, steps from University College Hospital, in 1844.Footnote ¹⁹ From this location, Lewis set out to attract the custom of the medical men who passed through the neighbourhood. His shop offered discounts for cash purchases, and housed a circulating library featuring his own works on hygiene, surgery, physiology, gynaecology, and disease. Although Lewis also issued other kinds of books, these services and the firm’s geographic position associated it with the hospital, making it, as Callow’s shop was remembered, something of a medical institution itself.

Publishers also integrated themselves into the fabric of medical life by cultivating their social networks. Churchill made many connections by attending medical society meetings and hosting doctors in the back room of his bookshop on Prince’s Street, where he gossiped with them by the fire in the evenings, “skimming the cream of general politics and medical scandal.”Footnote ²⁰ These occasions consolidated his reputation as a man who, while not a doctor himself, had a deep understanding of the profession and its needs. The surgeon James Fernandez Clarke recalled receiving his first medical apprenticeship through Churchill. A friend of Clarke’s uncle, the publisher recommended him to a surgeon in St. Giles after conducting a terrifyingly rigorous interview.Footnote ²¹ All the while, Churchill took every opportunity to situate his business within a deeper historical context: at medical society meetings, in the medical press, in his correspondence, in his promotional materials, and eventually in his memoirs, the publisher reminded medical men of the relationships that he had forged with esteemed physicians and surgeons, and of his connection to Callow, the father of medical bookselling who had set him on his path.

Additionally, publishers signalled their belonging in medical communities by linking themselves with the profession’s governing structures in print. Just as regular and irregular practitioners alike often highlighted their status (or purported status) as members of the Royal Colleges and other medical institutions on the title pages of their books, publishers who enjoyed the patronage of such institutions frequently noted the fact in promotional material, even in cases when that patronage conferred no particular privilege. Baillière, the London-born son of a French publishing and bookselling family whose firm also had offices in Paris and Madrid, billed himself “Publisher and Foreign Bookseller” to the Royal College of Surgeons, the Royal Society, and the Royal Medico-Chirurgical Society in advertisements.Footnote ²² Highley, who had managed John Murray’s medical department and took much of its business with him when he and Murray parted ways in 1803, heralded his status as “Bookseller to the Royal College of Surgeons of England.”Footnote ²³

Situating themselves within these interwoven geographic, social, and institutional spaces, medical publishers portrayed themselves as helpmeets to the profession who worked tirelessly to facilitate medical training and communication between experts. Their activities did greatly assist these enterprises. Churchill’s series of medical directories for the United Kingdom, begun in 1846, connected doctors with clients, tradespeople, and each other. The medical journals that he, Highley, and others published, which ranged from specialist periodicals, such as the Asylum Journal of Mental Science, to general ones, like the Medical Times and Gazette, expedited a more public form of communication between practitioners in different parts of the country. Publishers like Baillière, with his international connections, facilitated exchanges of knowledge between practitioners in different countries by issuing translations and foreign editions. Many books that were adopted as standards for medical training, such as Henry Gray’s Anatomy: Descriptive and Surgical (1858), issued by Parker, were brought out by specialist medical publishers. And, through circulating libraries like Lewis’s, which counted several hospitals among its subscribers, medical men could read these works cheaply and conveniently.

Admittedly, medical publishers’ portrayals of themselves as happy servants of the profession sometimes stretched the bounds of credulity. Churchill represented his advertising circular, the Medical Intelligencer, as a service devised to keep practitioners informed of the “Progress of Medical Literature,” A considerable portion of the second number’s cover in 1854 is devoted to illustrating how expensive it was for Churchill to put out, showing through a breakdown of costs that he had spent £156 7s 6d to print 15,000 copies of the circular, place them in envelopes, stamp them, and send one, unsolicited, to “every Medical Man in the United Kingdom whose address can be ascertained.”Footnote ²⁴ Just as readers of R. and L. Perry & Co’s broadcasts about the company’s advertising expenditures were meant to conclude that it invested in advertising because it was confident in the efficacy of its patent medicines, readers of the Medical Intelligencer were meant to conclude that Churchill was not just in medical publishing for the money. Reading between the lines, it’s clear that doctors were not the only beneficiaries of Churchill’s medical directories. They were also a useful tool for marketing purposes.

Publishers like Churchill took every opportunity to promote themselves as assets to the profession because doctors regularly questioned their motives and morals. They whinged about the quality of the books that medical publishers put out, and grumbled about prices they charged for them, portraying them as mercenaries who put their own profits over the needs of the profession.Footnote ²⁵ Churchill’s tireless efforts at self-promotion paid off eventually. On his death in 1875, he was toasted in the medical press for his ability to see “a want, [suggest] the kind of work likely to fulfil that want, and … put his finger on the man who has leisure and talent sufficient to write it.”Footnote ²⁶ However, winning medical men over was not quick or easy. Two decades earlier, a medical journalist had speculated that Churchill commissioned books by “throwing a certain number of subjects into one hat, … [and] the names of medical men into another, and draw[ing] forth both at random.” Allegedly, “the nominees” – medical men who, this journalist claimed, were asked to write books more for their famous names than for their literary talents – “resort[ed] to mere compilation … wholesale appropriation from their neighbours” or ghost-writing to deliver their manuscripts on time.Footnote ²⁷

Medical men wrote more darkly about the existential dangers of giving publishers too much control over medical communication. Some envisioned scenarios in which a small number of publishers came to possess “at one and the same time the copyrights to the chief standard medical works, and also those of the medical periodicals.”Footnote ²⁸ Such corporate monopolies would not only give outsiders to the profession the power to dictate the prices of medical books and periodicals but also enable them to dictate the terms of publishing them. This state of affairs would surely degrade medical literature and reduce its criticism to puffery. Occasional battles between publishers and medical practitioners, like one explosive episode between Michael Ryan and the London Medical and Surgical Journal’s publisher, Henry Renshaw, lent credence to these concerns. In 1834, Renshaw reportedly pressured Ryan to publish an enthusiastic review of a “quackish, catch-penny, and most absurd work” in order to retain its author’s advertising business, and then demanded that Ryan puff nostrums advertised on the journal’s wrapper.Footnote ²⁹ Ryan may have been accused of dabbling in quackery himself, but he considered this behaviour beyond the pale: he ended the journal’s partnership with Renshaw. Furious, he moved to expose the publisher after Renshaw continued to issue a version of the London Medical and Surgical Journal under a more malleable editor, and sent threatening letters to booksellers demanding that they stop selling Ryan’s version.Footnote ³⁰

Concerns that publishers presented a threat to the profession’s integrity were the most frequently raised by, or expressed in the organs of, advocates of radical medical reform like Ryan and Wakley, editor of the Lancet. In seeking to “raise up” the profession, medical reformers not only aimed to make over medicine’s public image but also aspired to transform it from within by rooting out self-serving behaviour, dismantling hierarchies of governance that fostered inequities among practitioners, and installing a fair system for regulating medical practice.Footnote ³¹ One of the early missions of the Lancet, whose initially combative, vernacular style was inspired by radical periodicals like T. J. Wooler’s Black Dwarf (1817–9), was to expose the corruption of medical elites and fight against the power of the Royal Colleges, institutions that Lancet writers argued exerted a “monopoly” over medicine.Footnote ³² From 1840, the more subdued Provincial Medical and Surgical Journal (later, the British Medical Journal), the mouthpiece of the Provincial Medical and Surgical Association (later, the British Medical Association), offered lowly general practitioners living outside London a voice against those same elites.Footnote ³³ Medical publishers, who emphasized their connections with elite medical institutions and sought to profit from medical expertise, were seen by some writers for these organs as the worst of both the irregular and the elite medical worlds, either in thrall to or aspiring to replace the monopoly of the Royal Colleges with a publishing monopoly.Footnote ³⁴

Just as publishers like Churchill were working to consolidate a foothold in the industry, medical reformers began to argue that only an independent medical press, divorced from the commercial publishing establishment and the oversight of the Royal Colleges, could ensure that communication on medical matters in print was equitable and ethical.Footnote ³⁵ In the 1840s, many advocated the formation of private subscription societies to publish many, and even all, of the books required for medical training and reference.Footnote ³⁶ As well as ensuring independence, medical reformers claimed, subscription publishing societies could make medical works vastly cheaper and equalize practitioners’ access to them. The publishing model they proposed had some promising precedents.Footnote ³⁷ Even at the proposal stage, though, reformers quarrelled about exactly what kinds of works medical publishing societies should issue, and worried that they would not attract enough subscribers to sustain them.Footnote ³⁸ An appeal to general practitioners for donations to keep the Provincial Medical and Surgical Journal running in 1842 was so unsuccessful that the Association was forced to bail it out.Footnote ³⁹ The outlook for a subscription publishing society charging a guinea per annum – the subscription rate proposed by most advocates of these societies – did not look good.

The Lancet’s claim, in 1854, that “two or three leviathan booksellers” supplied the country with all of its medical books and journals – “publishing what they please, rejecting what they please, and then puffing their own wares in their own journals” – was not quite true.Footnote ⁴⁰ Medical publishing continued to be performed by a variety of players through the mid-nineteenth century. And although they never achieved the kind of influence that some medical reformers wanted, a few medical publishing societies were established, and one, the New Sydenham Society, was quite successful.Footnote ⁴¹ The Lancet was correct, though, in that two firms, Churchill and Baillière, dominated the market for professional medical books and journals by the middle of the nineteenth century. With its robust international network, including new branches in New York and Melbourne, Baillière was the country’s largest supplier of foreign medical books and translations, while Churchill was the largest domestic producer. As the Lancet commented in 1857, “the publishing of medical books is now conducted under monarchical government, and … Mr. Churchill holds the sceptre with a firm hand.”Footnote ⁴²

The services that career publishers offered proved impossible for medical men to resist. Working without the burden of medical duties, they were able to manage the complicated, time-consuming work of ushering manuscripts into print and organizing their advertisement and distribution – kinds of labour that the organizers of medical publishing societies found very difficult to perform efficiently. However, publishers were not necessarily trusted to put the medical profession’s interests above their own. As the next section shows, the same was true for medical authors. In theory, the way regular medical authors typically published books – with the assistance of a publisher – distinguished them from men like Joseph Lambert and William Dugdale. In theory, the publisher’s imprint conferred a kind of institutional approval that marked a medical work, and its author, as legitimate and respectable. And in theory, the publisher stood between the author and the market, insulating him from direct contact with it. However, alongside persistent distrust in publishers’ abilities to work in medicine’s best interests, the economic contexts of medical publishing and medical practice undermined these functions of the publisher, and supported a continuous undercurrent of suspicion, particularly in the reforming medical press, that a great deal of regular medical authorship was only superficially distinct from quackery. This suspicion mediated debate about propriety in publishing works on sexual and reproductive issues within the regular medical community, and intensified concern about how works on these issues were being advertised and sold by those outside it.

The Publisher as Agent

Publishers like Churchill and Baillière were hardly the ruthless mercenaries that their critics made them out to be. They aspired to establish reputations for issuing books and journals of real quality, and cultivated their lists carefully. They developed relationships with respected doctors, kept their eyes peeled for promising young authors, and tried to steer clear of works that they thought would smack of quackery to the professional readers they courted.Footnote ⁴³ But while they prized quality, a book’s potential to make a profit, or at least break even, was important. As Churchill declared on several occasions, “a publisher swims or sinks by the exercise of his judgement.”Footnote ⁴⁴ Economic considerations weighed heavily in negotiations between authors and publishers, influencing the length of the final product, the quality and number of its illustrations, its material design, and the way it was framed. Observing in 1843 that “small monographs” like one proposed by the surgeon Langston Parker, a specialist in venereal disease, “seldom pay to the publisher,” for instance, Churchill suggested printing Parker’s work in the same format as his previous book, Modern Treatment of Syphilitic Diseases (1839).Footnote ⁴⁵ One hundred and fifty copies of Modern Treatment remained unsold. Churchill thought that marketing the new book as a companion to the old one could speed sales of both, and imagined binding them together to create a new work if that strategy failed to raise demand for Modern Treatment.Footnote ⁴⁶

Unfortunately, such adjustments could not always make a worthy book from a professional point of view a sound financial investment. Churchill declined more than one manuscript because he judged it “more calculated to advance [the author’s] scientific reputation, and consequently to promote [his] professional status, than repay commercially.”Footnote ⁴⁷ Such a book might look too similar to a bestseller to achieve good sales, or its topic might be too specialized to attract much interest. For the authors of such books, however, there was another resort: they could cover the cost of publishing it themselves. Churchill frequently apprised authors of this option during the 1840s and 1850s, when he was establishing himself as Britain’s largest medical publisher.Footnote ⁴⁸ After politely expressing doubt that a book would be sufficiently lucrative to justify risking his investment, he would suggest that the author cover the costs of publishing and advertising it himself. Churchill would take a fee for arranging the publication, and the author would have rights to the profits. If Churchill’s instincts were wrong, and the author’s “expectations of a successful sale [were] justified, [he] would not be kept long without a return for [his] capital.”Footnote ⁴⁹

Paying the costs of publishing one’s own book did not carry the same stigma that it does today. The arrangement, often termed commission publishing, was extremely common for most of the nineteenth century.Footnote ⁵⁰ Even so, it attracted opposition: critics argued that commission publishing exploited authors and fostered the overproduction of books with narrow, and sometimes non-existent, readerships. Commission arrangements did benefit publishers by guaranteeing that they would make a modest profit in exchange for the labour of bringing a book out. They also allowed – and to some extent encouraged – publishers to issue more books than they would have under other circumstances. This effect of publishing on commission could damage a publisher’s reputation, if it led to an indiscriminate list, but, in the right hands, it could be beneficial. By increasing his stock of medical books, commission publishing made it possible for Churchill to promote himself as the publisher of “a larger number of Medical Works than are issued by all the other publishing houses” by the early 1850s and situate himself as the most powerful medical publisher in the industry.Footnote ⁵¹

The benefits of commission publishing were less straightforward for authors. Although some very successful writers chose to publish on commission to maximize their profits, most risked heavy financial losses.Footnote ⁵² Including the costs of paper, typesetting, and printing; binding and advertising fees; free presentation copies for friends, colleagues, and reviewers; and the publisher’s ten percent fee for arranging the book’s publication, marketing, and distribution, issuing 500 copies of a typical medical book cost between seventy and ninety pounds. This was a serious investment, given that an income of between £300 and £500 signalled a “fair degree of success” for general practitioners working in London.Footnote ⁵³ Authors publishing on commission would have to spend considerably more to bring out a book if it contained charts or illustrations, if it was lengthy, or if it was published in a large format. Commission publishing was also open to abuse. Authors were aware, for example, that publishers could charge posted fees for advertising a book in venues where they were, in fact, able to advertise it at a discount or for free.Footnote ⁵⁴

Why, then, did so many medical authors publish on commission? It is doubtful that they thought they would make a profit. Publishers readily acknowledged that even the most successful medical writers rarely made enough to live on, and that losses were virtually guaranteed for authors who entered commission arrangements.Footnote ⁵⁵ Many doctors published anyway because they wanted to make a lasting contribution to medical knowledge. Some aspired to shape medical training, and some to influence public policy. But the prospect of “professional advantage” was another incentive.Footnote ⁵⁶ Furnishing a doctor with publicity and cultural capital, authorship could attract new clients to his practice. A book could make him sufficiently known that he might be invited to lecture to medical students, offered a hospital position, and come to the attention of the country’s wealthiest patients. Experiences like John Elliotson’s, whose annual income soared from £500 to £5,000 in the space of just one year following the publication of a series of influential clinical reports in the Lancet, acted as grist for the ambitions of many medical men.Footnote ⁵⁷ (Elliotson’s fall from grace after he started to champion mesmerism acted as another, less inspiring, lesson in career strategy.)Footnote ⁵⁸

The economic context of medical practice further explains the appeal of publishing for professional advantage.Footnote ⁵⁹ From 1815, an over-supply of doctors made it very difficult to become established in private practice. The incomes of established medical practitioners were also woefully unpredictable, partly because they faced robust competition for patients and partly because patients often delayed or neglected to pay their bills. While irregulars demanded that patients pay for consultations in advance, regular practitioners deemphasized the transactional nature of the doctor–patient relationship by billing patients afterward.Footnote ⁶⁰ Authorship was seen as a way for young medical practitioners, and especially young physicians, to distinguish themselves from the fray, and for established practitioners to stabilize their income. Secured on the basis of their status as published experts, hospital appointments could furnish senior medical men with greater economic security as well as higher social status in a status-conscious profession.

Publishing for professional advantage was so widely recognized as a career strategy that it was the subject of innumerable satires. “Having familiarized people with your name,” one collection of “Private Hints to a Young Physician” instructs, “it behoves you then to give it notoriety; therefore, lose no time in getting into print … A Treatise on Indigestion has gained many a physician a sumptuous dinner … the physician of the Irish Viceroy is indebted for his livelihood to a little book on gout.”Footnote ⁶¹ But while such pieces emphasize that publicity was a desired effect of publishing a medical book, they also emphasize that publishing a book for this purpose was not looked on as entirely respectable. It looked dangerously close to advertising. Some medical men considered it little more than a veiled form of quackery.Footnote ⁶² This situation helps explain the virulence of medical opposition to practitioners like Joseph Lambert, particularly in organs for medical reform like the Lancet. Consulting surgeons represented serious economic competition and associated a profession trying to portray itself as learned and disinterested with naked commercialism. At the same time, consulting surgeons’ publishing practices drew attention to an ambiguity between publishing and advertising in regular medicine that was a source of significant professional discomfort.

In this context, commission publishing was often portrayed as a dangerous practice – under such arrangements, was the medical publisher really anything more than an advertising agent? – and medical authorship was subject to constant, informal policing. Medical journals were run through with gossip that this or that practitioner wrote books purely for the purposes of self-promotion. This mode of policing did little more than exacerbate authors’ anxieties about being misunderstood, however, because it did not resolve a fundamental problem: the rules for publishing in the right ways were unwritten, contingent, and contested. Authors could not circumnavigate the risk of an accusation by declining to write on certain topics. Works on venereal disease, fertility problems, and male sexual dysfunction often aroused suspicion, since these topics were now tightly associated with quackery, as did medical autobiographies, which highlighted the author’s accomplishments.Footnote ⁶³ However, even a book on aural disease could be seen as an advertisement in disguise.Footnote ⁶⁴ Nor were there clear rules for how to write a medical book. Writing a derivative book could be risky. Compiling was faster than writing from scratch, and some practitioners viewed compilation as the trademark of the self-serving author. Yet, compilations were also praised in the medical press as useful syntheses of established knowledge. Moreover, a book could be too original. If he wrote a book that recommended “some new invention … in the shape of an instrument, or a medicine, or a peculiar line of treatment,” an author risked being seen as over-eager to promote his ingenuity.Footnote ⁶⁵

Promoting a medical book was even more fraught. In the eyes of many medical reformers, medical books were less often advertisements themselves than they were excuses for advertising. A respectable practitioner could not advertise his address or fees for consultations or publish testimonials without offending his colleagues. All had been considered quackery in medical circles since the eighteenth century. Publishing a book, however, enabled him to get his name into the press without technically advertising his practice. The Medico-chirurgical Times called using a book as a proxy for promoting a medical practice “auto-advertising.”Footnote ⁶⁶ In practical terms, however, it was far from clear what distinguished this form of advertising from normal book promotion. Some medical men considered having one’s book too widely or too regularly advertised in the non-medical press unseemly, but their opinions about what constituted excessive advertising varied. Some medical men took umbrage at those who paid to have their books listed in certain venues, such as the Medical Circular’s “Guide to Living Authors,” a directory of medical authors that printed their addresses alongside the titles of their books. Since contact information for medical authors was available through professional societies, the guide’s critics argued, it had no purpose beyond providing non-medical readers with the addresses of medical men with expertise in particular areas.Footnote ⁶⁷ Yet, the fact that the Guide existed at all suggests that many practitioners did not see it this way.

Balancing regular practitioners’ collective disapproval of advertising with medical authors’ desire to sell their books and make their names proved to be as difficult for publishers as it was for authors. Anxious to attract authors, medical publishers often broadcast their skills at getting a book noticed. On taking over John W. Davies’s medical publishing business in 1864, Robert Harwicke took out an advertisement in the Lancet which announced that he had “at his command the requisite means for giving extensive publicity for Works published by him.”Footnote ⁶⁸ The largest medical publishers often emphasized the advantages that their status as publishers of journals afforded for publicity. As Baillière put it to one author, “our connection with so many medical journals does give us special advantages [in advertising] … + where it is in our power, as is frequently the case, we put adverts of works in which we have a pecuniary interest, in gratuitously.”Footnote ⁶⁹ Churchill alluded to this power in print, announcing in one of his catalogues that his journals offered authors “a wide extent of literary announcement, and a medium of advertisement, addressed to all classes of the profession.”Footnote ⁷⁰ However, such efforts to highlight a publisher’s strengths could be perceived as evidence of underhanded practices. Churchill’s boast was interpreted by one writer to the Lancet as a scandalous admission of puffery:

Medical works on sexual and reproductive matters could be especially tricky to promote in this environment. The topics they addressed were often associated with irregular medical practice and thus with self-promotion, and some were also considered particularly attractive to prurient readers, and thus subject to abuse by publishers and authors alike. The unruly space of the print marketplace, where titles issued by many different kinds of players mixed and mingled, exacerbated these problems.

The Medical Publisher’s List

Medical publishers issued a wide variety of works that addressed reproduction and sexual health. Because compilation was such a common way of making new books during this period, the content of many of these works overlapped with that of works examined in previous chapters. However, they were distinct from the productions hawked by men like William Dugdale and Joseph Lambert in many respects. They were larger, heavier, and better produced, with thicker paper and more precise illustrations. While they became increasingly affordable over the first decades of the Victorian period, they were often more expensive, too – sometimes dramatically so. The implied audience of these works was also different: they usually addressed medical, or at least professional, readers. Moreover, they had a very different relationship with the state. As well as establishing, extending, and amplifying discourses that regulated sex and the body by setting standards for bodily form and function, sexual behaviour, and sexual desire, some of these works overtly supported state interest in managing sexual and reproductive practices.Footnote ⁷² For all of these reasons, it is not especially intuitive to examine trade in such works alongside the pornography and consulting surgeon trades. As elements of the previous sections suggest, however, distinctions that appear strong from a historical distance looked a lot shakier during the first decades of the Victorian period, and understanding this is key to understanding the politics of selling sexual knowledge at the time. Overlaps in how and why these works and works examined in previous chapters were sold, or were thought to be sold, aroused concern in medical circles, and this concern inspired action.

A general overview of the kinds of works medical publishers issued is helpful for establishing a more expansive understanding of trade in sexual knowledge during this period as well as its politics. Although they did not focus solely on sex or reproduction, medical publishers issued countless lectures, treatises, manuals, textbooks, and atlases on anatomy and physiology that included a great deal of information about the reproductive system and the transformations of adolescence. Such works often served as sources for the cheaper pamphlets and manuals examined in previous chapters. While some were plain, workaday titles intended for students cramming for examinations, others were lavishly illustrated works of art. Henry Gray’s landmark textbook Anatomy: Descriptive and Surgical (1858), which initially sold for twenty-eight shillings and was furnished with stunning wood engravings by the surgeon and artist Henry Vandyke Carter, stood in sharp contrast to cheap pocket editions of Aristotle’s Masterpiece and even manuals like Manhood, whose illustrations of the body were smaller, softer, and often older.

Alongside these works, medical publishers issued many works that focused specifically on sexual and reproductive health issues. Manuals, textbooks, and treatises on reproduction, gynaecology, obstetrics, and midwifery appeared in their catalogues year after year. As with the works on general anatomy and physiology, some of these productions were workaday compilations aimed at synthesizing existing knowledge or spare treatises oriented around describing new methods of treatment. Others were expensive and elaborate showpieces. Readers thumbing through Augustus Bozzi Granville’s stunning Graphic Illustrations of Abortion (1834), which was published by Churchill and initially cost more than two pounds, could gaze at forty-five lithographs and engravings illustrating embryos floating free against a velvety black background, as if suspended in a starless sky, or peep at the creature nestled in the cradle of the uterus, the organ’s layers peeled back to enable viewing like the skins of a shaggy onion.Footnote ⁷³ Robert Lee’s Anatomy of the Nerves of the Uterus, issued by Baillière in 1842, depicts the uterus with such full-colour realism that its illustrations look almost photographic.

Medical publishers also issued many books on the functions, disorders, and diseases of the reproductive organs which had a variety of purposes too. Some instructed practitioners in the aetiology and symptoms of specific health problems and promoted particular methods of treating them. John L Milton’s On a New Way of Treating Gonorrhoea (1852) is a good representative of this genre. Illustrated solely with tables of notes, it marches readers briskly through a series of case studies, provides instructions for applying Milton’s method of treating gonorrhoea, which involved injecting patients with silver nitrate, and argues against courses of treatment suggested by other practitioners.Footnote ⁷⁴ Other works organized and synthesized medical knowledge of reproductive health and disease more generally, or examined it from social, moral, behavioural, economic, or legal angles. William John Anderson’s Hysterical and Nervous Affections of Women (1853), a collection of lectures initially presented to members of the Harveian Society, examines the relationship between diseases of the uterus and psychological conditions in women, while William Acton’s Functions and Disorders of the Reproductive Organs (1857) examines male reproductive function and dysfunction over the entire life cycle within a matrix of “Social and Moral Relations.”Footnote ⁷⁵

Additionally, publishers like Churchill and Baillière issued works addressing issues related to sexual and reproductive behaviour that overtly aimed to support or influence the law and public policy. Some provided doctors with information that enabled them to aid the state in managing sexual behaviour. Alfred Swaine Taylor’s classic Manual of Medical Jurisprudence (1844), published by Churchill, shows doctors how to look for physical evidence of sexual crimes, including rape, sodomy, and bestiality.Footnote ⁷⁶ It also instructs readers how to determine whether a woman had been pregnant or delivered a baby, and how to distinguish cases of miscarriage from deliberate abortions, should medical expertise be called on during inquiries surrounding divorce, inheritance, infanticide, or criminal abortion. Other works were written to galvanize support for new laws, or bring about their abolition. William Acton’s Prostitution, Considered in Its Social, Moral, and Sanitary Aspects (1857), published in the same year as Functions and Disorders, urges state intervention to stem the tide of venereal disease, while Michael Ryan’s earlier Prostitution in London (1839), published by Baillière after Churchill dropped Ryan and modelled on Alexandre-Jean-Baptiste Parent-Duchâtelet’s influential De la prostitution dans la ville de Paris (1836), rails against the 1834 Poor Law Amendment Act. The Act, Ryan argues, exacerbated the spread of venereal diseases by forcing unwed mothers into prostitution.Footnote ⁷⁷

Finally, especially early in the Victorian period, medical publishers issued works that addressed sex and reproduction and their relations to marriage, heredity, and racial difference. These works were often written by radical medical practitioners interested in the political and philosophical applications of knowledge about anatomy, physiology, and reproduction, and sometimes inspired by bestsellers on related topics that had gained a wide general readership.Footnote ⁷⁸ Ryan’s Marriage was one of these works. Marriage was modelled on a proto-anthropological genre that emerged in the seventeenth century and remained popular throughout the nineteenth, which Lisa O’Connell calls the “marriage-rites genre.”Footnote ⁷⁹ Including works such as Louis de Gaya’s Cérémonies nuptiales de toutes les nations (1680) and Lady Augusta Hamilton’s Marriage Rites, Customs, and Ceremonies of All Nations of the Universe (1822), marriage-rites books presented readers with a cornucopia of information about marriage customs around the globe, from “bland descriptions of the minutae of wedding ceremonies and courtship procedures to commentary that reproduced received ideas about other worldly forms of sexuality,” such as “the amorousness of the French, the hot-blooded passions of the Italians and the Spanish, and the despotism of the polygamous Turks.”Footnote ⁸⁰ Compiled from a plethora of published sources, including previous works in the genre, marriage-rites books framed this knowledge as a cornerstone for understanding the universal nature of humanity, drawing connections between marriage in various traditions even as they exoticized “foreign” practices.Footnote ⁸¹

Ryan borrowed from marriage-rites books when he made his own Marriage, including passages that match verbatim with passages in Hamilton’s Marriage Rites.Footnote ⁸² The obstetrician’s innovation was to combine the descriptions of foreign bodies, climates, and customs that fill most marriage-rites books with lengthy discussions of anatomy and physiology, obstetric procedures, fertility problems, and medical curiosities, also mostly sourced from previously published works. In Marriage, Ryan argues that gaining a complete understanding of marriage as a universal did not just require acquiring cultural knowledge of foreign marriage ceremonies and practices like polygamy and eunuchism. Such a project also demanded gaining an understanding of the biological processes associated with reproductive life, and the medical knowledge and procedures that helped manage them. Physiology and obstetrics, Ryan claims, “materially influence population, morals, public health, disease, mortality; as well as personal reputation, property, legitimacy, and even life.”Footnote ⁸³ Considered holistically, marriage was cultural and biological. This was a perceptive argument – but it meant that Ryan’s Marriage contained more explicit discussions of the body than other marriage-rites books. Given this, and Ryan’s identification with (medical) radicalism, it is little wonder that William Dugdale sold it and renovated it.

Another example – also connected with disreputable bookselling – is Alexander Walker’s Intermarriage; or, The Mode in Which, and the Causes Why, Beauty, Health and Intellect, Result from Certain Unions, and Deformity, Disease, and Insanity, From Others, also published by Churchill, in 1838. Intermarriage is a sequel to Walker’s commercially successful Beauty: Illustrated Chiefly by an Analysis and Classification of Beauty in Women, an upmarket reworking of John Joseph Stockdale’s publication Kalogynomia, or The Laws of Female Beauty (1821) – which itself lifted parts of an 1815 essay of Walker’s, raising the possibility that Walker was Kalogynomia’s author.Footnote ⁸⁴ Walker, a radical lecturer on anatomy and physiology, imported Kalogynomia’s argument and much of its text verbatim when he created Beauty. He stitched this material together with a list of “mental defects” in women, lengthy passages evaluating the beauty of foreign and ancient women, and exegeses on biology, art history, and aesthetics. Kalogynomia and Beauty are very much alike. Where Kalogynomia presents readers with a mishmash of illustrations running the gamut of sexual explicitness, however, Beauty features an orderly series of engravings of nude women posed like classical statues. And while one is never too far away from a titillating passage in Kalogynomia, in Beauty these passages are enveloped in a dense cocoon of copied prose.Footnote ⁸⁵

Intermarriage is, in turn, similar to Beauty despite its announced focus on interracial and interclass reproduction. As in Beauty, as Rachel Walker notes, a clear “undercurrent of erotic desire” runs through Intermarriage.Footnote ⁸⁶ The work lingers on the “insanity” of sexual desire, the physical beauty of women of various “races” (and its defects), and “foreign” practices such as clitoridectomy. In offering this material, Intermarriage again recycles a great deal of text from Kalogynomia and Beauty – essentially offering a reprisal of the former in the middle of the book – as well as passages plucked from marriage-rites books, treatises on phrenology, and works on animal breeding.Footnote ⁸⁷ The book, as Damon Ieremia Salesa observes, represented “the fullest radical account of racial crossing” at the time, an account that approached intermarriage as a “‘reforming science’ aimed at … maximizing individual ability and preventing disease.”Footnote ⁸⁸ Yet, while it communicates original ideas about how to use medical knowledge to improve humanity, Intermarriage is also a bursting compendium of information about reproductive bodies and sexual practices, one that bears striking similarities to Ryan’s Marriage, Beauty, and the popular works that inspired them.

Pandering, Auto-Advertising, and Paratextual Contamination

Medical debate about publishing and advertising works in the extremely diverse body of literature that I have sketched surrounded three overlapping issues: “pandering” to prurient members of the reading public, “auto-advertising,” and something that I’ll call “paratextual contamination.” Each was thought to undermine medical authority and the upstanding, “scientific” identity for medicine that medical reformers desperately wanted to consolidate.

Given medical authors’ historically anxious attitudes towards publishing on sexual matters and overlaps between some of these works and works connected with the pornography trade, we might expect most of the debate to focus on the problem of pandering. As Ryan’s case suggests, medical journalists did level charges that a regular medical author sought to entertain the public with descriptions of sex and the body, or had come dangerously close to looking like they wanted to. Such charges usually surrounded works on topics thought to attract prurient readers, such as prostitution, masturbation, and obstetrics and gynaecology. However, these allegations were so rare by the Victorian period that I have only been able to identify a handful of examples, and they were unpredictable, often seeming to rely more on opinions of the author than assessments of the work. Ryan and Walker were both involved in the radical medical reform movement. Marriage and Intermarriage were issued by the same publisher only a year apart. Both were commercial successes: they attracted readerships far beyond the medical and were reprinted in several new editions at home and abroad. Ryan was harshly criticized for publishing Marriage on the grounds that it pandered to prurient readers. Kalogynomia, a work that substantially informs Intermarriage, was known for its connection with a scandalous publisher, and, as Chapter 7 shows, eventually seized as an obscene book. However, both Intermarriage and its predecessor, Beauty, escaped medical criticism: they were not seen as attempts to pander to prurient readers despite their similarities to works that were.

A related but also infrequent charge was that medical publishers pandered to prurient readers by commissioning rapidly knocked-up works on issues like prostitution with sales to the general public in mind. A review in the Edinburgh Medical and Surgical Journal that railed against Baillière for publishing an anonymous work called The Greatest of Our Social Evils, Prostitution (1857) offers a good example of these kinds of charges.Footnote ⁸⁹ Having published works on “mesmerism, hydropathy, homeopathy, and every other kind of suspicious subject,” this writer claimed, Baillière was now commissioning works on sexual matters “for the purposes of the book market.”Footnote ⁹⁰ The evidence that the Edinburgh reviewer provided was a four-page list of titles. It was not the works themselves, he maintained, but the number of them and the fact that they were clustered on the same page of Baillière’s advertising sheet that revealed his unsavoury motives for publishing works on these subjects. It “may be, that all of the books here quoted are … innocent of pruriency,” the reviewer admitted. “But the reader … will agree with us in thinking that the conjunction is ominous.”Footnote ⁹¹

The exponentially larger number of charges of auto-advertising levelled against authors of works on sexual matters emphasises that the idea that medical knowledge was being exploited to promote medical practice was seen as more of a threat to the profession’s credibility during this period than the idea that it was being prostituted to prurient readers, though as Ryan’s case suggests, these charges could overlap. Churchill, Baillière, Renshaw, Highley, and other medical publishers all advertised works that addressed sexual issues in non-medical periodicals. During the early 1840s, these advertisements appeared in just a handful of newspapers and magazines. However, they began to appear more regularly, and in a much wider range of venues, from the middle of the decade. By the 1850s, readers saw advertisements for works like Langston Parker’s Treatment of Secondary and Constitutional Confirmed Syphilis (Churchill, 1850), Samuel Bayfield’s Practical Observations on the Local and Constitutional Effects of Syphilis (Renshaw, 1858), and Francis Burdett Courtenay’s On Spermatorrhoea (Baillière, 1858) in the classified pages of conservative newspapers, such as the Standard; sporting papers, such as Bell’s Life in London; and Sunday periodicals, such as John Bull. Churchill advertised works on women’s reproductive health such as Anderson’s Hysterical and Nervous Affections of Women (1853) in the Lady’s Newspaper, an illustrated broadsheet for upper-class women.

Why did medical publishers advertise in these spaces? One reason may be that medical practitioners read non-medical newspapers and magazines, often more frequently than they read medical journals. Another reason may be that the lines between the categories of professional and popular reading material were blurrier than they are today. Just as middle and working-class readers bought manuals that excerpted works aimed at medical practitioners, middle- and upper-class readers often bought such works themselves. Although the implied audience of George Spratt’s Obstetric Tables is medical students, for instance, a review in the Athenaeum anticipated that monied readers would find it attractive as a collector’s item.Footnote ⁹² Readers of all classes also turned to medical textbooks to learn about the body and sexuality. Undigested by editors, textbooks could be difficult to navigate, however. Allen Clarke, the son of provincial textile workers, skimmed through physiology textbooks in the public library in hopes of learning more about sex and reproduction but found them “incomprehensible.”Footnote ⁹³ Middle-class readers like the novelist George Eliot, who read anatomy and physiology textbooks aloud with her partner, George Lewes, in the evenings, found them easier to work through. However, even Eliot switched to lighter books after dinner.Footnote ⁹⁴

Interest in capturing crossover readerships may be one of the reasons that prices for medical works dropped precipitously in the first decades of the Victorian period, a pattern that tracks the general trend toward cheap print explored in previous chapters. However, medical practitioners’ perennial complaints that books were too expensive are more likely the main reason that medical publishers decided, as Churchill put it, that it was “better to realise a profit from a large number [of books] at low prices, than from the sale of a limited number at high prices.”Footnote ⁹⁵ In 1842, the cheapest work on sexual or reproductive issues advertised by a medical publisher in the non-medical press was Francis Burdett Courtenay’s five-shilling Nature and Cure of Strictures of the Urethra.Footnote ⁹⁶ Twelve shillings was a more typical price, and some works were much more expensive.Footnote ⁹⁷ Between the late 1840s and 1860, however, prices for these works plummeted to a median two shillings and sixpence, matching the prices of many Holywell Street productions.

Although it is possible to interpret medical publishers’ newspaper advertisements as attempts to reach practitioners who rarely read medical journals or to capture cross-over readerships, writers in the medical press often interpreted them differently: in their eyes, these advertisements were “auto-advertising” at work. As Milton observed in A New Way of Treating Gonorrhoea, the number of works on gonorrhoea and syphilis listed in the catalogue of the library of the Royal College of Surgeons of England had increased exponentially between the seventeenth century and 1844, the year Milton’s book was published, despite the fact that knowledge of these diseases and methods of treating them had barely advanced. The sheer number of works on venereal disease being published each year offered evidence, Milton suggested (apparently unaware of the irony of doing so in a book called On A New Way of Treating Gonorrhoea), that most practitioners were publishing simply to promote themselves. “Patients,” he lamented, “have been half scalded in hot baths; the penis has been almost frozen with cold lotions; nay, the patient has been enjoined not to make water in the streets lest the penis might take cold,” not on the basis of new knowledge but because doctors wanted to make names for themselves.Footnote ⁹⁸

Even when medical journalists thought that a work made an important contribution to knowledge, they increasingly interpreted its advertisement in the non-medical press as self-promotion: under the proxy of advertising a book, medical men were announcing to readers that they had the expertise to treat their health problems. Medical publishers’ book advertisements were notably more restrained than consulting surgeons’ notices. They were shorter, and eschewed flowery descriptions of the book’s contents and its author’s expertise. They provided no information about the location of the author’s medical practice or his fees; mentioned no associated medicines or devices; and offered less information, and sometimes none at all, about where one might obtain a copy of the book. Yet, as medical journalists often pointed out, the prevalence of commission publishing arrangements meant that publishers’ advertisements for medical books were frequently paid for by authors themselves. In 1851–2, for instance, part of the commission that William Acton paid John Churchill covered fees for advertising his Practical Treatise on the Diseases of the Urinary and Generative Organs in Both Sexes (1851) in a variety of periodicals, including The Times, the Athenaeum, and Bell’s Life in London.Footnote ⁹⁹ According to their critics, the only thing that separated such authors from irregulars like Joseph Lambert was the fact that the publisher put his name on the advertisement: a prophylactic against the appearance of quackery.

In regular medical circles, then, concerns about selling sexual knowledge had shifted from the turn of the century, when William Burke anxiously informed readers of his Popular Compendium of Anatomy (1804) that they would find nothing in his book that would “be in the least offensive to the delicacy of a chastened and correct mind.”Footnote ¹⁰⁰ Regular practitioners’ anxieties about presenting sexual information to the public had become more and more interwoven with, and in some contexts almost swallowed by, anxieties about the fact that those who published and advertised books on these issues could be seen as quacks, or were, in fact, falling into quackery: degenerating from learned and disinterested men of science into low-class exploiters of knowledge for economic gain. This shift in the focus of medical anxieties about presenting sexual knowledge maps on to the increasing number and visibility of irregular publications on sexual health problems and advertisements for them, and medical reformers’ increasing determination to distance medicine from market interests. As debates about what I call “paratextual contamination” show, the convoluted geography of the print marketplace compounded and extended concerns about the meanings and effects of advertising medical books in non-medical spaces. Medical men worried that the close proximity of regular and irregular publications in the space of the marketplace fostered confusions of professional identity that seriously undermined the medicine’s reputation and legitimate practitioners’ incomes.

Medical publishers occasionally issued books for doctors who were associated with irregular practice or who became associated with it over time: Churchill published an anatomical atlas for Joseph Kahn in 1852, for instance, and the Madrid branch of Baillière’s firm issued J. L. Curtis’s Manhood in Spanish in 1853.Footnote ¹⁰¹ More frequently, retailers sold regular and irregular medical works alongside each other. In the early 1840s, readers could find Manhood and R. and L. Perry & Co’s The Silent Friend in Baillière’s bookshop in Regent Street.Footnote ¹⁰² During a period in which periodicals multiplied and newspaper advertising skyrocketed, it was the fact that regular and irregular medical works were advertised in many of the same spaces, however, that became a subject of ongoing complaint in the medical press. In the eyes of many regular practitioners, there were very important differences in the content of regular and irregular medical book advertisements. However, these differences were not necessarily obvious to non-medical readers. Medical publishers promoted titles on the same or similar subjects as irregulars, and their advertisements necessarily employed some of the same language: for instance, medical publishers also advised readers that they could purchase books through the mail in exchange for postage stamps (though they did not offer the option to receive purchases in sealed envelopes).

In this context, the spatial proximity of medical publishers’ and consulting surgeons’ advertisements on the newspaper page became a focus of particular concern in the reforming medical press. Newspaper editors usually grouped the latter together at the bottom of their advertising pages, but they did not, as the Lancet complained, draw a “quarantine” around them. As a result, notices for regular and irregular publications often appeared “next door” to each other, bringing them into association on the space of the page (Figure 3.1). Medical writers worried that this practice made works like Manhood and The Silent Friend look legitimate, and thus enabled men like Joseph Lambert to make “enormous” incomes, “all filched from the profession … or extorted from the public.” They also worried that bringing regular medical works “into contact with these abominations” on the page made regular medical works look illegitimate.Footnote ¹⁰³ Medical writers often called on newspaper editors to stop publishing consulting surgeons’ advertisements, claiming that it would benefit them by attracting more advertising business. Many authors “have been deterred from advertising books in such papers, in consequence of observing those under the head of ‘new publications’ placed in juxta-position” with consulting surgeons’ notices, one medical journalist argued.Footnote ¹⁰⁴ Some dreamed up creative solutions that would enable newspaper editors to publish advertisements of both kinds while clearly separating them on the page. The Lancet proposed that editors “place blocks of non-conducting puffs between [consulting surgeons’ notices] and the better sort of advertisement – Grimstone’s snuff, Solomon’s spectacles, or any other rubbish, might be used for such a purpose.”Footnote ¹⁰⁵

Figure 3.1 “Next door” advertisements for regular and irregular medical works in Bell’s Life in London and Sporting Chronicle, February 14, 1858, 2. Content provided by The British Library Board, with thanks to The British Newspaper Archive.

Envisioning newspaper editors protecting medical publishers’ advertisements from contamination by quarantining consulting surgeons’ advertisements on the page, the Lancet’s proposal neatly illustrates regular practitioners’ anxiety about being associated with quackery even as it reveals how this anxiety competed with their desire to reap the benefits of publicity through print. The image of the “non-conducting puff” also echoes the role that publishers played in mediating these anxieties: they insulated medical authors from direct contact with the market. Yet, this was a precarious arrangement, one threatened by suspicion of publishers’ motives, suspicion of authors’ motives, and concern about the confusions of professional identity that consulting surgeons actively encouraged and that the crowded geography of the print marketplace helped facilitate. Overlaps in the publishing and advertising practices examined in this and the previous chapters really do seem to have fostered confusions of identity even in the medical community, as a student’s letter to the Medical Times about a book he had seen Baillière advertising in the press in 1851 illustrates. “Is the author of the ‘Philosophy of Marriage’ (published by Baillière, Regent-street.) the Dr. Ryan,” the letter reads, “or does it emanate from some parties assuming his name, in the ‘Silent Friend’ style?”Footnote ¹⁰⁶

The first decades of the Victorian period marked great changes in medical publishing and book advertising. By the middle of the nineteenth century, the print marketplace was awash with medical writing on sexual matters and teeming with different players whose products and practices blurred together in multiple ways. This chapter aimed to demonstrate anxiety about this situation in regular medical circles, where it came from, and where it was directed. There was an increasing sense, particularly among medical reformers, that something had to change if medicine was to develop itself into a coherent, “scientific” profession that was perceived as trustworthy and worthy of public trust in the first place. Initially, this did not involve serious attempts to discipline regular medical publishing or book advertising, however. Instead, as the next chapter shows, amid mounting assaults on the Holywell Street trade by anti-vice crusaders, organs of reform like the Lancet attacked consulting surgeons on the grounds that they peddled “obscene quackery.” This progression affirms Michael Brown’s argument that defining a collective identity for medicine first entailed firmly situating “those deemed ‘unorthodox’ in knowledge, practice, or education” outside the profession.Footnote ¹⁰⁷