Branwell Brontë, brother of the novelists Charlotte, Emily, and Anne, noted the title of a work that interested him in a battered notebook. “manhood. the causes of its premature decline,” he scribbled, “by J. L. Curtis & Co, London.”Footnote ¹ It was 1841. Brontë was living in Luddenden Foot, a tiny village in West Yorkshire, and trying to forget that he was a failure. He aspired to be a painter and a poet. Yet, his portraits had not sold, his poems had been refused by publishers, and his letters to influential authors and artists had gone unanswered.Footnote ² He had been relieved to find employment as a tutor for the sons of a retired country magistrate, only to be sacked less than a year into the job. Rumour had it that one of the servants was pregnant with his child.Footnote ³ Brontë was now working as a clerk on the new Leeds and Manchester railway line. Luddenden Foot’s rail station was little more than a shack, and trains did not come through it often. Brontë wiled the days away by doodling in his ledgers and, reportedly, matched the alcoholic station-master pint for pint.Footnote ⁴ How could J. L. Curtis’s Manhood: The Causes of Its Premature Decline with Directions for Its Perfect Restoration (1840) not attract the eye of a man who, at only twenty-four, believed that he had failed to live up to his potential? The title must have seemed to speak to Brontë personally, to promise an explanation for his struggles, and a guide to setting things right.

Manhood was not made for Branwell Brontë, but it was created for, and found an international audience in, young men like him. In 1841, the work was being advertised all over the British Isles. A decade later, it had been translated into four European languages and was being promoted all over the world. By 1855, readers from Lima to Madrid, Calcutta to Adelaide would have been familiar with Manhood’s title, if not the work itself. Advertisements for it appeared everywhere: in the classified sections of local newspapers, in the back pages of travel guides and how-to books, on the walls of military barracks and back alleys, and above public urinals. Issued under a pseudonym by a medical practitioner named Joseph Lambert, or possibly Joseph La’Mert, Manhood’s longevity is as striking today as its globe-spanning circulation. Lambert sold various editions out of his premises in Albemarle Street, West London, into the 1870s, and others hawked it under a variety of titles and attributions into the early 1900s. Yet, Manhood was not an extraordinary publication. It was merely one of the more successful of a panoply of cheap manuals on venereal disease and sexual debility that began to deluge the print marketplace in the 1840s. People who framed themselves as experts in the treatment of sexual problems made, published, and sold these works at the local, national, and sometimes international levels, supported by a finely tuned advertising machine that far surpassed Holywell Street publishers’ in the sheer volume of its output.

The author-publishers of these manuals usually called themselves “consulting surgeons,” adopting a term from hospital practice, and that is the term I will use to refer to them here – not because they were the only practitioners to use the title but because the only other term closely identified with these figures was a pejorative: “quack.”Footnote ⁵ Deriving from the Dutch kwakzalver, a term for “a person who cures with home remedies,” “quack” often implied a doctor who exaggerated his expertise or claimed to effect miracle cures.Footnote ⁶ However, in medical circles it was also volleyed at practitioners who made a more benign error: “those who tell the truth in their advertisements, but, doing so [i.e. advertising], adopt a course not countenanced by the profession.”Footnote ⁷ Self-promotion was considered uncouth in the class-conscious medical world. Medical men were supposed to develop reputations sufficient to support a career by patiently cultivating – or being born with – social networks.Footnote ⁸ Quacks embraced a lower-rent way of attracting patients, one that, in the eyes of other doctors, aligned medicine with the low social status and moral quagmires of trade: they spoke to prospective patients directly through public lectures, demonstrations, and, now most of all, through print.

Many consulting surgeons would have qualified as quacks under both definitions of the term. All of them qualified under the latter. They not only made massive investments in print advertising but also exploited the multifunctionality of the book to advance their interests. The cheap manuals that they created by compiling excerpts from existing publications offered Victorian readers a cornucopia of information about reproduction and sexual health. At the same time, the manuals acted as instruments that consulting surgeons used to cultivate trust in their expertise and facilitate the sale of other products and services. The techniques that consulting surgeons used to make and sell these works were similar to Holywell Street publishers’. However, this chapter argues that their effects on the market for sexual knowledge were quite different. The incestuous nature of the copying involved in creating consulting surgeons’ manuals and the sheer scale of their circulation meant that they blanketed the Victorian world with a standardized model of sexuality that soldered desire with male weakness. Ubiquitous in foreign and especially colonial territories, trade in these manuals can be thought of as an element of cultural imperialism, one that displaced indigenous knowledges in India, Australasia, the Caribbean, and North and South America with a mass-produced model of sexuality imported from Europe.

At first glance, these manuals and their makers are unlikely characters in a book that explores debate about medical works’ potential to deprave and corrupt. Consulting surgeons’ manuals were not known as bawdy books, nor did they invite such a reputation. Their representations of sex and the body imported from their sources a highly technical focus on anatomy and physiology, and they displayed images of disease and disability that readers typically framed as the opposite of erotic. Nor did these manuals obviously encourage sexual rebellion: one of their most notable features is their extreme, conservative moralism. Even so, these manuals entered the story this book tells because their makers exploited an ambiguity that, as we will see, aroused greater anxiety among regular practitioners during this period than the blurry boundary between the medical and erotic: the uncertain line between information and advertisement. By exploiting that ambiguity, consulting surgeons threatened regular medicine economically and existentially. Their self-identification as medical experts and their use of print as a vehicle for self-promotion attracted patients in droves and associated a profession anxious to assure the public that it was learned and trustworthy with the low status of trade and the exaggerations of advertising.Footnote ⁹ Moreover, their manuals seemed to undermine the credibility of all medical literature. These cut-and-paste productions raised the question of whether it was possible to distinguish between published evidence of expertise and a hollow performance aimed at extracting profit.

Paper Museums

The brashly commercial brand of medicine that consulting surgeons engaged in had existed since the seventeenth century.Footnote ¹⁰ Almost immediately after the printing press was introduced to Britain in 1476, medical practitioners had seized the opportunity to spread word about their remedies through print.Footnote ¹¹ The ending of government licensing for printing and publishing in 1695 gave them freer rein to experiment with the medium, and set off a boom in the production of vernacular works aimed at readers who were not medical experts.Footnote ¹² As Mary Fissell has shown, informational and promotional print forms quickly became entangled in this context. Medical guides and pamphlets coexisted with handbills advertising medical practice in early modern print culture, with practitioners often using each form to present themselves in a different way. However, these forms also merged into a hybrid genre that functioned simultaneously as instructive reading material and as advertisements for medical products and services, a genre demonstrated by some of the contraception pamphlets examined in the previous chapter.

By the late eighteenth and early nineteenth centuries, this hybrid genre – “the most commercial and market-like [aspect] of medical print,” Fissell notes – had become especially associated with trade in remedies for impotence, infertility, and venereal disease.Footnote ¹³ James Graham’s Lecture on the Generation, Increase, and Improvement of the Human Species (c. 1783), hawked by Holywell Street publishers decades after Graham’s death, offers a great deal of information about procreation. It also suggests a variety of means through which readers could preserve or enhance their fertility, including by seeking out customized advice from Graham “at the very moderate price of ONE GUINEA.”Footnote ¹⁴ Other examples include Samuel Solomon’s three-shilling Guide to Health, or, Advice to Both Sexes (1782) and William Brodum’s two-volume, five-shilling Guide to Old Age, or Cure for the Indiscretions of Youth (1795), which warned readers against masturbation on the grounds that it would harm them physically, mentally, and morally, and promoted their authors’ cures for the damage.Footnote ¹⁵

Trade in these kinds of manuals skyrocketed around 1840. Over the next twenty years, it only increased even as prices plummeted from a median three shillings in 1840 to below one shilling in 1860.Footnote ¹⁶ Like Georgian irregulars before them, consulting surgeons advertised their manuals in a wide range of venues and sold them directly to customers and through networks of newspaper offices, bookshops, stationers, and apothecaries. However, they took advantage of expanding transport infrastructures to sell them across much wider geographic distances. As with Holywell Street productions, Britons could order consulting surgeons’ manuals directly from addresses listed in advertisements, pay for them with postage stamps, and have them delivered in a sealed envelope for a fee of one or two pence. By the late 1840s, readers in the British colonies had relatively easy access to many of these manuals, which were advertised in newspapers and almanacs in Canada, Australia, New Zealand, and India.Footnote ¹⁷ Colonial readers could pick up copies from local booksellers, or order them directly from London for a six-penny fee.

A few consulting surgeons gained a truly global audience from the late 1840s by having their manuals translated into other languages (Figure 2.1).Footnote ¹⁸ Joseph Lambert’s Manhood was translated into German, French, Spanish, Dutch, Danish, and Polish and issued in a variety of foreign countries by local publishers. Although the Danish and Polish translations appear to have been unauthorized, the rest were commissioned by Lambert himself. The Jordan family, owners of Perry & Co, the medical firm that issued one of Manhood’s chief competitors, The Silent Friend (1841), had the work translated into Italian and French and printed abroad under similar arrangements. Samuel La’Mert, Lambert’s brother, had perhaps the widest international reach: he issued his manual Self-Preservation (1841) in German, Russian, French, Dutch, Italian, Spanish, and Portuguese.Footnote ¹⁹ Notices for these translations were extremely common in Europe, Latin America, and the Caribbean throughout the mid-nineteenth century. Readers in Barcelona, Rotterdam, Paris, and Torino, Rio de Janeiro, Lima, Caracas, and Havana saw advertisements for J. L. Curtis’s De la virilidad and Manbaarheid, Perry & Co’s L’ami discret and L’amico discreto, and Samuel La’Mert’s A preservação pessoal in cheap books and local newspapers among notices for estate sales and employment announcements.Footnote ²⁰ As in Britain and its colonies, foreign-language readers were instructed to purchase the manuals in person from local booksellers or to write to purchase them by post.

Figure 2.1 Title pages of three editions of J. L. Curtis, Manhood. Manhood: The Causes of Its Premature Decline […]. (London: Published by the Authors, [1852]), De la virilité; des causes de son déclin prématuré […]. (Paris: Charpentier, 1851), and De la virilidad, de las causas de su decadencia prematura […]. (Madrid: C. Bailly-Bailliere,1853).

Courtesy of The Bodleian Libraries, University of Oxford, (OC) 160 c.11, CC-BY-NC 4.0, The Bibliothèque Nationale de France, 617.463 (23e éd.), and the author’s private collection.

When they received their orders, what readers would have found in their hands was a small, slender book, usually bound in cheap cloth or paper boards, whose design strongly emphasized its intended audience: people with no medical education. Along with the binding, size, and weight of the volumes, the title pages of consulting surgeons’ manuals set them apart from solid octavo tomes intended for medical practitioners. Hearkening to older print traditions, they featured lengthy subtitles that spelled out, in shifting sizes and styles of type, details about what was contained within that would now, in a book written for medical men, be left to the table of contents. Readers did not have to rely on bibliographical clues, however, to know that they were these manuals’ target audience. They could simply scan the subtitle. J. Jordan & Co’s Human Frailty (1842) describes itself as “a popular medical work.” I. A. Jacques & Co’s The Secret Preceptor (1852) brands itself “a popular treatise.” La’Mert’s Self-Preservation calls itself “a popular inquiry.”Footnote ²¹ This presentation was not meant to suggest a watered-down summary of medical facts but to imply democratized knowledge: that these manuals, as the introduction to Horace Goss’s Woman: Her Physiology and Functions (1853) proclaims, enabled “readers who may be ignorant of the structure of the human body, to arrive at a clear and proper knowledge of the wonderful mechanism of man.”Footnote ²²

Most of these manuals delivered on their promise to provide the uninitiated with a real medical education. The first fifty pages of The Silent Friend present readers with detailed information about how the parts of the body operate in tandem, like “that complex and delicate piece of machinery, a watch.”Footnote ²³ A series of engravings, furnished with labels identifying anatomical features, accompany the work’s review of anatomy and physiology, which sets up two longer sections devoted to “derangement and impairment of [the] function and structure” of the human body: “Onanism and Its Consequences” and “Venereal and Syphilitic Diseases.” The latter describes in detail how gonorrhoea and syphilis are contracted, what their symptoms are, and how they should be treated. Like the section on anatomy and physiology, this section is furnished with engravings. One brings together five images of the penis and testes, swollen, leaking, and marred with syphilitic sores. Another depicts chancres on the inner thighs and abdomen. Although many people probably perused these manuals out of sheer curiosity, marginalia suggests that they were used as a means of self-diagnosis: some readers customized them by annotating them with recipes for medicines to treat issues described in the text.Footnote ²⁴

Consulting surgeons’ manuals thus offered people a means of understanding their bodies in modern, “scientific” ways, grounded in the study of anatomy, that older popular works, such as Aristotle’s Masterpiece, did not.Footnote ²⁵ It is important to recognize, though, that these manuals enabled some people to understand their bodies better than they did others. Although it does cover female anatomy, physiology, and experiences of venereal disease, the focus of The Silent Friend is overwhelmingly male experience. Not one of its engravings depicts a female body. This was typical of the genre, which, like some of the works examined in the previous chapter, primarily addressed young men like Branwell Brontë: unmarried, equipped with a small amount of disposable income, and desperately in search of self-knowledge. At least two manuals for women were issued in Britain, however, and they provided comparably detailed information tailored to female concerns: R. J. Swaine & Co’s Geneseology, or, The Physiology of Woman (1850) and Goss’s richly illustrated Woman, which circulated in Britain for at least twenty-five years.Footnote ²⁶ Each offers a compendium of information about the anatomy and physiology of the female body, pregnancy, miscarriage, labour and delivery, menstruation, venereal disease, injuries from childbirth, and fertility.

Like The Silent Friend, Woman invites readers to gaze in wonder at the marvellous mechanisms of the human body even as it tacitly acknowledges a range of practical reasons that a woman would seek out a book on reproductive health. Unlike male-oriented manuals, which tend to have few but lengthy chapters, Woman is organized as a reference book, with a series of short sections indicated in the table of contents. A reader who was trying to conceive could consult the manual’s introductory “Observations on Generation,” which describe the mechanics of coition and conception, and causes of infertility. A reader preparing for the birth her first child could thumb through to a series of engravings that illustrate the delivery of a baby and the placenta (Figure 2.2). A reader who had suffered a miscarriage – or was hoping to induce an abortion – could refer to a series of tables that describe the appearance of embryonic tissue at various stages of development. A reader who suspected that she had contracted a venereal disease could compare her own vulva with illustrations depicting the vulvas of diseased patients.

Figure 2.2 Plate 10, illustrating childbirth, in Horace Goss, Woman: Her Physiology and Functions (London: Published by the Authors, 1853), (OC) 160 c.66, Weston Library, Oxford.

Courtesy of The Bodleian Libraries, University of Oxford, CC-BY-NC 4.0.

In addition to providing readers with medical information, consulting surgeons’ manuals offered a moral lesson, one that was, again, mostly aimed at men. Women’s sexual health problems are portrayed as beyond their control in manuals for both genders: their origins lie in the capricious nature the female body and the actions of careless, faithless men.Footnote ²⁷ In men, the same health problems are depicted as the consequences of abject failures of self-control. Readers may have found The Silent Friend’s descriptions of anatomy and the symptoms of gonorrhoea and syphilis enlightening. If they read the work from cover to cover, however, they would have had to pass over lengthy descriptions of the suffering of men who failed to master their sexual urges, and lectures that decried the selfishness of those who brought venereal disease to the marriage bed:

While sex is framed as a self-affirming activity in many Holywell Street productions, in consulting surgeons’ manuals sexual desire is collapsed with male weakness. Desire, as Ellen Rosenman has observed, produces flaccid, leaking male bodies; disordered, incontinent minds; disease-ravaged wives; deformed offspring; broken relationships; and shattered ambitions. In order preserve their manhood in every one of its senses, men must become masters of their desires, denying themselves pleasure even to the point of rationing marital intercourse.Footnote ²⁹

Medical journalists often deemed these works’ descriptions of the perils of sexual indulgence “disgusting, demoralizing, [and] deceptive.”Footnote ³⁰ Yet, as historians have often pointed out, they trafficked the same ideas as works written for medical specialists. French treatises like Léopold Deslandes’s De l’onanisme et des autres abus veneriens (1835) and Claude François Lallemand’s Des pertes séminales involontaires (1836–44), and the English medical works that they inspired, alleged that even behaviour that did not spread venereal disease, such as masturbation, damaged men, feminizing them by weakening their bodies and reducing the “penis, symbol and site of virility … to a vulnerable, flaccid body part.”Footnote ³¹ In fact, the relationship between these works and consulting surgeons’ manuals was even more concrete. Consulting surgeons did not simply take ideas from other publications. They took their words. Works like Manhood, The Silent Friend, and Woman were not written so much as they were assembled. While Holywell Street publishers tended to revise and reframe existing works for new audiences, consulting surgeons habitually generated content out of them, tearing passages, paragraphs, and occasionally whole chapters out of multiple books, pamphlets, and articles to create productions of their own.

It can be difficult to determine exactly which sources the authors of these manuals used to create them because compilation was such a common method of composition at the time. The American practitioner Seth Pancoast’s Porneio-Kalogynomia-Pathology: Boyhood’s Perils and Manhood’s Curse (1858) appears to borrow from Kalogynomia, or The Laws of Female Beauty (1821), the hybrid of medical description and erotic narrative examined in the previous chapter, for example, but it could theoretically have borrowed from some of Kalogynomia’s sources instead.Footnote ³² That said, much of the text in these manuals matches verbatim with writing in standard textbooks on anatomy, physiology, and surgery, such as Sir Astley Cooper’s Lectures on the Principles and Practice of Surgery (1825). Books on sexual debility and venereal disease, including John Bacot’s A Treatise on Syphilis (1829) and John Roberton’s On the Diseases of the Generative System (1811), or translations of foreign works on these topics, including Deslandes’s and Lallemand’s treatises, also appear to have been common sources. Others include midwifery textbooks, anti-masturbation pamphlets like Onania: or, The Heinous Sin of Self-Pollution (c. 1712), works on the history and philosophy of marriage, including Michael Ryan’s Philosophy of Marriage (1837), and works that had inspired the consulting surgeon’s manual as a genre, such as Simeon Solomon’s Guide to Health. Chunks of text in Manhood, ranging from paragraphs to pages, match material in most of the works I have named.Footnote ³³ Woman’s content seems to have been derived from textbooks for medical students and encyclopedia entries on midwifery, embryology, and anatomy.Footnote ³⁴

That these works are compilations would not necessarily be obvious to a casual reader. Consulting surgeons combined parts of other publications skilfully. They often expanded excerpted text with writing of their own, modernized the language of excerpts from old books and pamphlets, made excerpts from specialized textbooks and treatises more accessible by omitting, paraphrasing, or explaining technical terms, and changed the implied audience where necessary. For instance, while Sir William Lawrence instructs surgeons how to relieve painful symptoms of gonorrhoea in his Lectures on Surgery (1830):

Manhood explains the procedure to prospective patients:

Even so, it is possible to read consulting surgeons’ manuals less as original productions than as showcases: their authors gathered information and perspectives from a variety of works and framed them so that they spoke in new ways to new audiences.Footnote ³⁷

Indeed, the consulting surgeon’s manual arguably functioned as the paper equivalent of the public anatomical museum, another popular Victorian source of sexual knowledge.Footnote ³⁸ Emerging in Europe in the eighteenth century, these urban attractions were inspired by collections of models and specimens used for training in medical schools. Entry to medical school collections was usually restricted to students, lecturers, and governors. However, anyone could enter a public anatomical museum for a shilling during daytime hours, or half a shilling between five and ten o’clock in the evening, a convention introduced in the 1830s to encourage working-class attendance.Footnote ³⁹ Just as consulting surgeons did in the first pages of their manuals, the owners of Victorian public anatomical museums drew on the rhetoric of public education and working-class uplift to frame them as venues that provided ordinary people with vital knowledge, grounded in the science of anatomy, that enabled them to understand their bodies in revelatory ways. “Know Thyself!” was a constant refrain in advertising material for these destinations.Footnote ⁴⁰

The kinds of knowledge that people gleaned from the manuals and the museums roughly matched up too. Just as readers of The Silent Friend were treated to a detailed lesson in anatomy, visitors to Rackstrow’s Museum in London, one of the city’s first public anatomical museums, were urged to gaze at specimens of skulls and brains, wax models of the nervous and respiratory systems, and a full-body “anatomical Venus” outfitted with glass vessels filled with a fluid that looked like blood.Footnote ⁴¹ But getting to know oneself also entailed getting to know the reproductive self in isolation. Displays of embryos in various stages of development, models of pregnant women, and exhibits devoted to illustrating the effects of venereal disease were routine features of these museums. Some historians have argued that like illustrations in consulting surgeons’ manuals, these exhibits taught visitors how to check their bodies for signs of disease, though museum owners (again, like consulting surgeons) typically framed them as lessons in the benefits of chastity.Footnote ⁴²

Public anatomical museums and consulting surgeons’ manuals were also alike in that they both repurposed tools initially created for medical students. As glass jars containing preparations multiplied in medical school collections, duplicates were deaccessioned and sold off at auction, where they were bought up by museum owners and put on public display. After the passage of the 1832 Anatomy Act made cadavers easier for medical schools to come by, wax and plaster models previously used for instruction were also sold off in large numbers. While it is sometimes suggested that museum owners displayed models depicting venereal disease solely to titillate or horrify, Maritha Burmeister has theorized that they initially became common in public anatomical museums because they were plentiful in the second-hand market.Footnote ⁴³ Rendered in wax, models of venereal disease were considered excellent teaching tools: evidence of disease on the skin could be observed in models in ways that were impossible when working with illustrations and even with patients.Footnote ⁴⁴ Old models regularly made their way to auction as more up-to-date models were introduced.

Education went hand in hand with entertainment more explicitly in public anatomical museums, however, than it did in consulting surgeons’ manuals. Early nineteenth-century public anatomical museums had more in common with Wunderkammers than teaching collections: they displayed models and specimens of human body parts alongside replicas of Greek statues, stuffed exotic animals, and Egyptian mummies.Footnote ⁴⁵ From the 1830s, as they aligned themselves with public education movements, they became more self-consciously “scientific.” Victorian anatomical museum owners often declared that their displays sought “not to gratify a prurient curiosity, but to present the scientific observer with a general and correct view of the perfect and wonderful structure of the body.”Footnote ⁴⁶ Even so, they catered to fascination with sexual and racial difference. Joseph Kahn’s Anatomical and Pathological Museum in London, one of the largest in the metropolis, exploited Britons’ lingering memories of Saartjie Baartman, the Khoikhoi woman known for her buttocks and genitals who had been displayed in London in 1810 under the name Hottentot Venus. Kahn displayed Baartman’s likeness in an ethnological exhibit called the Gallery of All Nations alongside wax models of various racial “types” and exhibited the “enormous” labia of other Khoikhoi women in glass jars alongside the preserved genitals of European men and women, bringing the unsavoury conclusion of The Lustful Turk to life.Footnote ⁴⁷

In some cases, museum owners created displays that straddled the line between fact and fiction in the interest of attracting visitors. One of Kahn’s displays, introduced in 1855, depicted the “Niam-Niams of Central Africa,” a people supposedly burdened with an “elongation of the vertebral column” which resembled a tail. An image of the wax display in a pamphlet issued to promote it depicts a nude family. The father and child expose their buttocks, revealing a short, tail-like appendage. The mother reclines. Her hand covers her vulva, but her chest is thrust towards the viewer, displaying her breasts. Extrapolating on common colonialist depictions of indigenous Africans as “wild” and “savage,” the text accompanying the image portrays all of the family members as “lower animals” with primitive instincts and base appetites.Footnote ⁴⁸ Of course, such creatures did not exist. Indeed, Kahn’s pamphlet includes extracts from the Lancet that dismiss reports on which the display was based as “Oriental fantasy.”Footnote ⁴⁹ Despite his claim that his displays were not “exaggerated in the slightest degree,” however, Kahn promoted the myth on the basis that it was possible that men with tails existed. In Kahn’s telling, this justified displaying models of fictive people alongside real wonders of the human body, blending medical fact and imperialist fantasy.Footnote ⁵⁰

Until the mid-1850s, regular medical practitioners also treated consulting surgeons’ manuals and public anatomical museums very differently. Prominent organs of the medical profession attacked the former as “disgusting” and “deceptive” even as they spoke of the latter approvingly, opining that making the science of anatomy known to members of the public could only increase their confidence in medical expertise. The Lancet praised Kahn’s Museum when it opened in 1851, deeming its anatomical and ethnological models “very beautiful” and its guides well-informed.Footnote ⁵¹ Public anatomical museums soon became subject to medical opposition, however, and the Lancet reversed its opinion. This may be partly because some museum owners introduced audacious displays like the Niam-Niam exhibit to attract visitors, representing them as science. However, several historians have argued that rising medical opposition to these museums had more to do with the fact that museum owners were adopting the practices of, or forging partnerships with, consulting surgeons, shifting from being mere displayers of medical knowledge to claimants to practical medical expertise.Footnote ⁵²

According to Burmeister, the history of Kahn’s Museum offers a good sense of how and why owners of public anatomical museums and authors of their paper equivalents merged in the 1850s. Although his museum was a critical success, Kahn found it difficult to turn a profit from ticket sales alone. As he sought to make his business more profitable, he not only introduced more sensational displays but also began to offer medical services. In 1855, the same year in which he opened the Niam-Niam exhibit, Kahn began to advertise his availability for private consultations for sexual health problems illustrated in his displays, and hand out museum guides that included extracts from a one-shilling pamphlet on “obstacles to a happy union” called The Philosophy of Marriage which promoted him as an expert in their treatment. Unfortunately, no copy of the pamphlet survives today.Footnote ⁵³ However, the extracts suggest that Marriage was heavily inspired by, and consequently very similar to, most consulting surgeons’ manuals, down to the origins of its text in longer, more technical medical and scientific works.Footnote ⁵⁴

Even as he imitated consulting surgeons, Kahn charged them with pretended expertise. He was an especially vocal critic of Perry & Co, publishers of The Silent Friend. The company’s owners, the Jordan family, recognized public anatomical museums’ potential to attract customers, however, and found a diplomatic solution to their problem. The Jordans purchased anatomical models from Kahn to display in their consulting rooms, and then persuaded him to bring them into his business as silent partners.Footnote ⁵⁵ The museum quickly became a vehicle for promoting the Jordans’ business. Attendants began to distribute copies of The Shaols and Quicksands of Youth (1856), a version of The Silent Friend presented as Kahn’s work, to visitors, which directed readers to seek out a range of products and services that the Jordans offered under Kahn’s name. The partnership inspired many imitators.Footnote ⁵⁶ Aligned with consulting surgeons and their manuals, public anatomical museums became full-service destinations through which Victorians could acquire sexual knowledge through the actions of viewing, listening, speaking, and reading.

Copies of Copies

Consulting surgeons framed their manuals as democratic productions that made vital knowledge accessible to any literate person. It is crucial to recognize that they functioned in this way for many readers. However, as the fact that Kahn only began to sell them when he had a medical practice to promote emphasizes, their major function for their authors was self-promotion. Exploring how this function shaped the consulting surgeon’s manual can expand our understanding of the cultural implications of this strand of the trade in sexual knowledge and unpack its implications for other medics. Here, I wish to make two points. First, the techniques that consulting surgeons used to work up manuals that could persuade readers of their expertise led to a striking sameness in the ways they represented the body and sexuality: they blanketed Britain, and indeed the globe, with uncannily similar portrayals. Second consulting surgeons’ treatment of medical knowledge in print undermined its authority in the eyes of other practitioners, and implicated all medical works as potential fronts for self-promotion.

That the consulting surgeon’s manual was essentially a form of content marketing was not a secret. All of these manuals draw attention to their authors’ availability for consultations to diagnose health problems in person or by letter – sometimes in several different languages – in advertisements appended to the text, within the text itself, in footnotes, or in all of these places at once.Footnote ⁵⁷ Many manuals also recommend, and often incorporate stand-alone advertisements for, proprietary ointments, lotions, pills, balms, and tinctures to prevent or cure the same health problems. Like the manual itself, these products could be purchased by post or in person, at their authors’ consulting rooms, through chemists, druggists, booksellers, and newspaper offices scattered across Britain and, in some cases, at bookshops and newspaper-offices located in other countries.Footnote ⁵⁸ In contrast to the manuals, these products and services were expensive and probably only sought out by a fraction of the manuals’ readers. A guinea – the standard fee for a visit from an authoritative physician, a lesson from one of London’s better violin teachers, or a year’s subscription to a circulating library – was the going rate for a consultation.Footnote ⁵⁹

A course of medicine could cost far more. The Cordial Balm of Syriacum, a treatment for “weakness, debility, deficiency of natural strength, and relaxation of the vessels” sold by the authors of The Silent Friend, cost eleven shillings per bottle.Footnote ⁶⁰ Their Preventive Lotion, which allegedly removed “all danger from [the] indiscriminate sexual intercourse” that they sternly instructed readers to avoid, cost thirty-three shillings per bottle, or five pounds for a case of six.Footnote ⁶¹ Thankfully, financial ruin appears to have been the worst consequence of using these medicines, something that cannot be said of many regular treatments for venereal disease, which could contain mercury, arsenic, or sulphur.Footnote ⁶² According to one chemical analyst, the Cordial Balm of Syriacum contained “weak spirits, sweetened with moist sugar, and flavoured with aniseed, spearmint, benzoin, and tolu, with the addition, probably, of some tincture of cantharides,” blistering extracts from the beetle Lytta vesicatoria commonly used to treat venereal disease. The Preventive Lotion was “a solution of zinc, coloured with a vegetable dye.”Footnote ⁶³

Other aspects of consulting surgeons’ manuals functioned as promotional devices in more subtle ways. From the surgeon’s point of view, for instance, a major purpose of manual’s main text, tables, and illustrations was to cultivate trust in his expertise, giving the impression of a practitioner with an enormous breadth of learning and experience. Consulting surgeons reinforced this impression by employing paratextual devices that aligned them with elite medicine. Many published under aliases derived from the names of eminent medical practitioners, such as Perry, Cooper, and Brodie.Footnote ⁶⁴ They also claimed to be members of elite medical institutions, such as the Royal College of Surgeons of England, on the title pages of their manuals, or told readers that they consulted in famous hospitals. Not all of these claims were false. The Jordans merely had to emphasize the genuine qualifications of one of their own, Robert Jacob Jordan, to associate themselves with elite medicine, telling readers of The Silent Friend that they had “confided their prescriptions to a Physician of the Royal University of Erlangen, and Member of the Royal College of Surgeons of England.”Footnote ⁶⁵

Other features of these manuals aimed to persuade readers to avail themselves of the expertise that they saw displayed on the page. Medical journalists often suggested that their searing accounts of suffering were engineered to send readers into a frenzy, inspiring panicked purchases of patent medicines or hurried arrangements for consultations. Journalists considered detailed descriptions of spermatorrhoea, a disease thought to result from the excessive discharge of sperm whose symptoms were supposed to include “anxiety, nervousness, lassitude, impotence, and, in its advanced stages, insanity and death,” especially effective for this purpose because spermatorrhoea’s symptoms were easily brought on by hypochondria.Footnote ⁶⁶ Tales of the devastating effects of scanning these manuals were rife in the medical press. Before perusing a consulting surgeon’s manual, one story went, a young man “never had any idea that men were liable to such a malady,” but after reading it, “he began to fancy that he might, perhaps, unknowingly, labour under the disease.” He visited its author and was informed, of course, that his “urine was loaded with semen.” A fee-book for treatment was produced, and the hapless man was persuaded to part with a hundred guineas for a cure he did not require.Footnote ⁶⁷

The manuals’ vivid descriptions of decline may well have had this effect. However, it is doubtful that they would have been effective had consulting surgeons not also worked to demonstrate that they were sympathetic to their readers’ problems, and that they recognized the need for delicacy and discretion in treating them. As a rule, consulting surgeons’ manuals assure readers that the details of medical consultations, and even the fact that a consultation has taken place, will be kept strictly confidential. “I am enabled to afford relief without even knowing the residences of the parties who receive it at my hands,” a typical note on discretion claims. “Inviolable secrecy, and certain relief, are the boons, then, that I offer to suffering humanity.”Footnote ⁶⁸ Goss’s Woman repeatedly addresses concerns about privacy specific to women. For instance, the author emphasizes that those seeking expert treatment would not have to be examined by, or forced to relay personal details to, a male medical practitioner. Prospective patients could choose to consult Goss’s wife, a “Consulting-Accoucheuse” who had the “discretion of a lady” and expertise equal to her husband.Footnote ⁶⁹ Should readers find it difficult to imagine writing or speaking to a consultant of any gender about embarrassing health problems, they could turn to the manual for help. Most manuals offer detailed descriptions of the kind of information that should be included in a letter to the author, and some even tell readers how to structure one. Should readers remain uncertain, they could model their letters on the “cases” that fill the back pages of many consulting surgeons’ manuals: anonymized letters or rewritings of letters allegedly posted to the authors from clients which testified to their skills and experience.

While it was framed as – and functioned for many people as – an informational genre, the consulting surgeon’s manual was thus overwhelmingly oriented around cultivating trust in a particular consulting surgeon or firm of surgeons, and persuading readers to avail themselves of their services. Everything about it aimed to convey a very individualized impression of the author(s) and their expertise. And yet, as the ease with which I am generalizing suggests, these manuals were extraordinarily alike. They were not just put together using the same methods. Nor did they simply hew to a predictable set of generic conventions. They also drew on very similar, and frequently the same, materials. The images of flaccid penises and swollen testes, syphilitic chancres and drooling onanists that appear in these works are interchangeable, and, as the examples in Figure 2.3 suggest, are often different copies of the same illustrations.

Figure 2.3 Different copies of the same illustration. Plate 1 in I. A. Jacques, The Secret Preceptor (Newcastle on Tyne: Published by the Authors, [1852]), Plate 10 in Samuel La’Mert, Self-Preservation (London: Published by the Author, 1852), and Plate 3 in John A. Lewis, Controul of the Passions ([Liverpool?]: Published by the authors, [1854]).

By courtesy of the Bodleian Libraries, University of Oxford, (OC) 160 c.31 and (OC) 160 c.37, and The University of Liverpool Library, SPEC 2017.a.023.

The same is true of the manuals’ textual content. Although most of the text in consulting surgeons’ manuals originated in works in other genres, the manuals share enormous amounts of that text with each other. The 1852 edition of Manhood and the 1844 edition of Brodie’s Medical Work on Virility alone share over 4,000 words of verbatim text, or about ten percent of the text of each manual. The 1852 edition of Manhood also shares substantial amounts of verbatim text with The Silent Friend, Self-Preservation, extracts from Kahn’s Philosophy of Marriage, C. J. Lucas and Co’s Manly Vigour (1841), The Secret Preceptor (1852), Walter de Roos’s Silent Hints on Certain Subjects (1852), Henry Smith’s The Warning Voice, or Private Medical Friend (1860), and L. J. Kahn’s Nervous Exhaustion: Its Cause and Cure (1870); and these works share substantial amounts of verbatim text with each other that do not appear in Manhood. In addition to copying from other sources, consulting surgeons copied from their prior publications and from each other when they created their manuals, and also when they issued new, expanded editions.Footnote ⁷⁰ As a result, the descriptions of anatomy, venereal disease, and sexual debility that appear in these works frequently overlap verbatim. So, too, does the text of cases, of advertisements for proprietary medicines, of instructions for how to write to the author, and of anecdotes from medical practice: features of these manuals that were supposed to be specific to the author. The specificity of the consulting surgeon’s manual was a total fiction.

That these manuals promoted the same views of the body and sexuality and that they circulated so widely and for so long have some compelling implications for the history of sexual knowledge. Holywell Street publishers’ catalogues attest to great variety in the kinds of knowledge available in the Victorian print marketplace. Such publishers’ scavenging fostered diverse lists that incorporated models of the body and sexuality from different times, places, and perspectives. Consulting surgeons’ manuals demonstrate that roughly the same principles of composition could have the effect of standardizing and amplifying a single perspective. Regardless of whether the author was Perry & Co, Curtis & Co, or Joseph Kahn, these manuals spread the same view of sexuality as inherently white, male, and weak around and around. The same descriptions of drooling onanists and oozing penises filled colonial spaces at a time when indigenous people’s literatures on sexuality were being erased; European centres from Stockholm to Madrid; and cities across the United States, where local practitioners copied British manuals and claimed them as their own. Although most of these manuals were first published in the 1840s and 1850s, many reached later generations of readers as a result of continuous repackaging by their creators and by other agents: versions of the most successful consulting surgeons’ manuals were advertised around the world into the early twentieth century.Footnote ⁷¹

The scale at which some of these manuals were produced only strengthened this effect. Consulting surgeons’ claims about sales – Joseph Kahn bragged that he had sold a million copies of The Philosophy of Marriage by 1872, and others reported similar figures – are hard to trust since they appear in advertising material.Footnote ⁷² Court records suggest, however, that the most successful manuals were distributed in the tens and even hundreds of thousands in Britain, giving them a circulation comparable with many hymnals and primers.Footnote ⁷³ When the proprietors of Kahn’s Museum were prosecuted for distributing obscene material in 1873, an episode covered in Chapter 5, Joseph Smale, a printer working out of Hale Street, Southwark, testified that between 1866 and 1872 alone he issued 43,250 copies of The Philosophy of Marriage for Kahn’s museum, and 30,000 copies of another work (probably The Shaols and Quicksands of Youth) on a similar topic.Footnote ⁷⁴ These numbers reflect local production by a single printer over six years. Editions of Manhood and Self-Preservation were issued for decades by many agents in a number of different countries, in several different languages.

In these contexts, it does not seem surprising that in the 1920s and 1930s, long after doctors had stopped believing that masturbation ruined men’s health, many of the older men who wrote to sex education campaigners like Marie Stopes worried that they had destroyed their bodies by indulging in it.Footnote ⁷⁵ That these views lived on cannot entirely be attributed to manuals like Manhood, of course. Old medical ideas enjoyed extended lives, especially in rural and working-class communities where people gained much of their information about sex and reproduction through oral tradition. And, as Holywell Street publishers’ mocking of these works suggests, not everyone took their warnings about the dangers of sexual indulgence seriously. That the same portrayals of weakened, feminized men, destroyed by their own desires, circulated around the globe for several generations must have had some effect on people’s ideas about sex and gender, health and morality, however. Although knowingly reading old medical knowledge was a common early Victorian experience, for later readers so, too, was encountering late Georgian and early Victorian medical perspectives posing as up-to-date information.

The fact that medical journalists often derisively referred to consulting surgeons and their expertise as “stereotyped” helps unpack the implications of their collective standardization of sexual knowledge for other claimants to medical authority. Stereotyping was one of several new printing techniques that facilitated fast, cheap publishing during the mid-nineteenth century. Involving the use of a mould to cast an exact replica of a set block of type, it sped up the process of printing new copies of successful publications. Instead of painstakingly resetting type when a book or pamphlet sold out, printers could simply dust off stereotype “plates” created from the type initially used to print it. It is probably not a coincidence that the growing popularity of stereotyping aligned with falling prices for consulting surgeons’ manuals and their growing circulation in colonial and foreign markets. Stereotyping made low-price, high-volume sales strategies more feasible, and facilitated transnational bookselling by enabling publishers to print their works abroad. Sending stereotypes from city to city and country to country was often cheaper than transporting publications themselves, which were heavier and more easily destroyed.Footnote ⁷⁶

In other words, stereotypes were copies that enabled the production of more copies. They “froze” previously mobile knowledge (or, at least, type) in place and facilitated virtually infinite commercial reproduction. The stereotype was an apt metaphor for consulting surgeons’ derivative, “arrested” performance of expertise, and the fact that medical journalists quickly took it on as a descriptor for their output – referring to “stereotype quack pathologies,” to consulting surgeons’ “stereotyped oration,” to the usual “stereotyped subjects of quack treatment” – offers insight into the nature of the anxieties that their practices aroused in other medics.Footnote ⁷⁷ Consulting surgeons packaged information largely produced by and for medical practitioners and used it to sell themselves to the public as experts over and over again. Like the false names and qualifications on some of their manuals’ title pages, the knowledge they claimed did not necessarily extend from anything more than copying. The uncanny sameness of consulting surgeons’ manuals made this obvious to other practitioners and seemed to offer evidence that their authors were not legitimate experts. The manuals’ obvious function as a form of content marketing seemed to further expose consulting surgeons as exploiters of expert knowledge for personal gain.

That other practitioners castigated authors of these manuals even in cases where they had formal medical training and were members of elite medical societies – Robert Jacob Jordan and Samuel La’Mert, for instance, both initially belonged to the Royal College of Surgeons – emphasizes that medical opposition to consulting surgeons was not simply rooted in concern about unqualified medical practice, however. It also derived from the feeling that consulting surgeons’ practices were a threat to medicine’s credibility. Consulting surgeons seemed to undermine medical authority by highlighting the profession’s interests in the market, and therefore its vulnerability to degenerating into charlatanism.Footnote ⁷⁸ At the same time, they undermined medical authority by simultaneously under- and over-performing expertise. Their manuals were theatrical, even lurid in their display of medical knowledge, and, yet, depthless, unapologetically derivative. Medical men might have claimed, had the term then existed, that the consulting surgeon’s manual looked like a gimmick, a form characterized by a mixture of laboured superfluity and disappointing vacuity that the critic Sianne Ngai has argued is capitalism’s most embarrassing aesthetic category.Footnote ⁷⁹ Because of its identification with medical practice, the consulting surgeon’s manual threatened to make medicine itself look like a gimmick: all flash for the crowds, and no substance behind it.

Cash in the Quack’s Corner

Thus far, I have argued that the challenge that consulting surgeons and, increasingly, owners of public anatomical museums presented for medical authority was essentially reputational. Even in cases where these figures were formally qualified medical experts, their brash commercialization of medical knowledge seemed to undermine medicine’s credibility as a trustworthy, scientific profession and the authority of its print culture. As we shall see, this potential effect on the profession greatly worried regular medical practitioners. However, the economic competition that consulting surgeons represented was also a source of serious concern for other medics. Given the global scale of some of the businesses I have described, I think that their concern about economic competition deserves closer attention. Nowhere is this concern more evident than in the ways regular practitioners discussed consulting surgeons’ use of direct advertising to promote their manuals. Ongoing features on consulting surgeons’ advertisements in medical journals chart other doctors’ increasing obsession with finding the answer to a single question: How much money did consulting surgeons make?

As I have suggested, consulting surgeons’ advertisements were absolutely everywhere during the mid-nineteenth century. Although they advertised their manuals on posters in public places, hired boys to distribute handbills promoting them in the streets, and paid publishers to insert advertisements for them in all manner of books, their advertisements were especially ubiquitous in periodicals. While Holywell Street publishers became wide advertisers in the 1840s and 1850s, they were small-time players compared to consulting surgeons, who advertised so widely and so frequently that many readers could be certain of encountering several notices for their manuals every time they bought a newspaper or magazine. Readers of the Morning Chronicle and of Reynolds’s Newspaper, of the Farmer’s Magazine and of the Banker’s Magazine, of Bell’s Life in London and of the Railway Record saw advertisements for Manhood and The Silent Friend in every issue. Between the late 1830s and the mid-1840s readers encountered a mean four advertisements for consulting surgeons’ manuals per issue in newspapers.Footnote ⁸⁰ By the mid-1850s, the mean had jumped to nine.

Women’s periodicals are the only secular genre in which advertisements for these manuals were uncommon. The fact that such periodicals carried many advertisements for treatments for fertility and menstrual problems emphasizes that this is not because irregulars ignored female complaints, however, but because they typically addressed men’s and women’s concerns differently in print. Men were perceived as reluctant to seek out medical advice and in need of persuasion to do so; women were considered either more open to persuasion through direct advertising or less able to spend time or money on manuals. Some of the drugs aimed at women were certainly as successful as some of the manuals aimed at men, and they were advertised and distributed in similar ways, on similar scales.Footnote ⁸¹ Widow Welch’s Female Pills, a drug company established in 1787 by the booksellers Catherine and George Kearsley, employed many of the same sales strategies as the authors of Manhood and The Silent Friend, selling pills to treat menstrual “obstructions” (phrasing that could be interpreted to suggest abortion or simply menstrual irregularity) by mail order in sealed envelopes across the country and around the world.Footnote ⁸² By the mid-1840s, when Lambert and the Jordans were just getting started on colonial sales, Widow Welch’s was already established in Australia. By the early 1870s, its pills were being advertised in Canada, India, and China.Footnote ⁸³

The bottom right-hand corner of a periodical’s advertising page was known as the “quack’s corner,” as this was the place where editors typically published both kinds of advertisements.Footnote ⁸⁴ This convention attuned readers to locating them quickly, a process that irregulars helped along by making their advertisements visually distinctive. Advertisements for books issued by literary publishing houses favoured the elegant aesthetics of white space: such publishers paid newspaper proprietors handsomely to spread out letters and words. Holywell Street publishers’ advertisements prized economy: they typically ran no more than eight lines, comprising a header, a list of short titles and prices, and an address. Advertisements for consulting surgeons’ manuals stood out because they were thick with description, creating a rectangle of text sometimes twenty times the size of adjacent advertisements. They were often the manuals in microcosm, offering chapter descriptions; details about their authors’ qualifications, addresses, and the times when they were available for consultations; snippets from endorsements and reviews; and, in some cases, promotional language for proprietary medicines (Figure 2.4).Footnote ⁸⁵

Figure 2.4 Advertisement for Perry & Co’s The Silent Friend. Shrewsbury Chronicle, September 7, 1849, 1.

Content provided by The British Library Board, with thanks to The British Newspaper Archive.

These advertisements aroused a variety of responses. Many readers found them compelling and wanted to believe their claims. As Anat Rosenberg has demonstrated, some readers collapsed the ubiquity of an advertisement with its trustworthiness: “I believed the statement contained in that advertisement for the reason,” one reported, “that I saw it, or a similar advertisement, a number of times.”Footnote ⁸⁶ Other readers considered consulting surgeons’ advertisements a nuisance. Just as the religious tracts that evangelicals issued by the ton from the 1830s came to be seen as junk mail, unasked for and unwelcome, readers often framed irregular advertisements as a kind of spam that clogged up textual space.Footnote ⁸⁷ The subject matter could make advertisements for consulting surgeons’ manuals especially irritating: when readers complained about them, they invariably recalled the embarrassment of seeing sexual health problems aired at the family breakfast table.

For medical journalists, these advertisements were a source of data: it was thought that they could enable estimates of the size of consulting surgeons’ businesses – and potentially the size of their income. In 1845, a writer for the Lancet searched seven daily papers, nearly a hundred weekly papers, and an unspecified number of “magazines, monthlies, and quarterlies … miscellaneous publications, and … country newspapers” for advertisements placed by five consulting surgeons.Footnote ⁸⁸ Collectively, these sources published 626 advertisements on behalf of the surgeons each week. By the Lancet’s reckoning, this added up to 32,650 advertisements a year. Since most consulting surgeons’ notices were lengthy, it estimated that they cost at least ten shillings apiece. This meant that five consulting surgeons alone probably spent more than 16,000 pounds a year on periodical advertising, two-thirds the amount that Richard Bentley, one of Britain’s largest literary publishers, spent on book advertising annually.Footnote ⁸⁹ Medical journalists used the same method to estimate consulting surgeons’ collective annual spending during the 1850s and 1860s. The figures they arrived at ranged between 50,000 and 65,000 pounds.Footnote ⁹⁰

As the authors of these studies often pointed out, however, these estimates did not cover a variety of advertising-related expenditures. They excluded the costs of paper, printing, and distribution for posters and handbills, and payments for placing advertisements in guides and almanacs. They also excluded the cost of puffs: allegedly independent writing about a consulting surgeon’s manual whose praise had been paid for.Footnote ⁹¹ Some puffs, as one journalist explained, were framed “as news … to draw attention to the advertisement” that the surgeon had placed elsewhere in a periodical.Footnote ⁹² Others masqueraded as independent reviews, which consulting surgeons often quoted in their advertisements, framing them as unasked-for endorsements.Footnote ⁹³ Given the nature of the manuals’ subject matter, puffs were sometimes evasive as to what they were actually about. One 1856 “review” of Manhood in the Mark Lane Express employs vague language about self-improvement to describe the manual, for instance, praising its commitment to addressing the “duty of all men to study the laws of their body no less than of the mind.”Footnote ⁹⁴

Medical journalists’ calculations also excluded international advertising costs, which would have significantly added to consulting surgeons’ overhead. Possibly to save money as well as time, consulting surgeons put little effort into adapting their advertisements for new geographic contexts. The advertisements that Joseph Lambert, the Jordans, and Samuel La’Mert placed in colonial periodicals are identical to the advertisements they placed in periodicals at home, save for the names and addresses of suppliers. Advertisements placed in foreign-language newspapers were often translated from British versions line for line.Footnote ⁹⁵ It is important to keep in mind, however, that identical advertising copy would have been interpreted differently in foreign and colonial contexts than it would have been in Britain. As Peter Yeandle has argued, for instance, advertising addressing concerns about “manly vigour” in the British colonies spoke to anxieties about white health and Western imperial strength in ways that it did not in Britain.Footnote ⁹⁶

Finally, bespoke advertising arrangements complicated attempts to calculate consulting surgeons’ advertising expenditures. Some newspaper proprietors reportedly charged irregulars 300 or 400 percent more than they did other customers, figuring that they could afford it.Footnote ⁹⁷ Apparently, this was especially true of puffs commissioned by “Secret Infirmity and Venereal gentlemen”: proprietors justified larger fees because the subject matter presented unique challenges for journalists tasked with presenting it as “news.”Footnote ⁹⁸ In other cases, consulting surgeons struck deals to make advertising less costly. Drawing on intercepted correspondence, one journalist reported that a surgeon paid a weekly Glasgow newspaper a flat rate of ten pounds for a twenty-one-week run of classified advertising and a weekly puff in the same paper.Footnote ⁹⁹ The proprietors of provincial newspapers seem to have been especially willing to work out bespoke arrangements. In some deals described by this journalist, consulting surgeons gave books and patent medicines to newspaper editors for free in exchange for puffs. The editors sold the goods to customers through their offices and pocketed the proceeds.

Consulting surgeons acknowledged that they spent a lot on advertising, and sometimes offered numbers of their own. In their own publications, however, they framed exorbitant spending on advertising as a sign of their concern for readers’ well-being, or of their faith in the efficacy of their remedies, encouraging readers to apply the logic that Rosenberg identifies. According to The Silent Friend, readers should interpret R. and L. Perry & Co’s campaign for the Cordial Balm of Syriacum as a sign of the company’s confidence in its product. “It requires the strongest conviction of its intrinsic worth and physical excellence, by long and great experience,” Perry & Co declared, “to induce the inventor or proprietor of any Medicine to incur the serious expense of making it known by advertisements; an expense of no less than £20,000 annually to Messrs. Perry and Co.” Indeed, Perry & Co claimed, “it could be of no avail to enter upon … the vast expense of making known such remedies, if their merits would not support their character when they were known.”Footnote ¹⁰⁰

Efforts at calculating consulting surgeons’ advertising costs ultimately foundered because it became clear that they offered limited insight into consulting surgeons’ operations. As one group of medical practitioners noted in 1850, even if it was possible to calculate consulting surgeons’ total domestic advertising costs, those costs must only scratch the surface of their outlay. Their gross annual incomes needed to be sufficient to cover the costs of printing and distributing their manuals, “binding, storing, the rent of several large houses in expensive parts of London, [and] the employment of numerous agents … as far off as Bombay and Calcutta.”Footnote ¹⁰¹ In the end, medical practitioners generally agreed that the gross annual incomes of the most successful consulting surgeons must exceed £30,000.Footnote ¹⁰² During a period in which £500 was a typical annual income for a successful general practitioner living in London, and annual incomes of £10,000 could be realized only by elite medical specialists, this was a staggering number.Footnote ¹⁰³

It was also a number that suggested an alarming disjuncture. Consulting surgeons’ position in the regular medical world was at its fringes. Yet, their position in the marketplace could hardly be characterized as “fringe.” They were a dominating presence in the Victorian market for advice on sexual and reproductive health issues. Consulting surgeons attracted patients who might otherwise have visited a practitioner who did not engage in “quackish” self-promotion, and they were not necessarily seen as meaningfully different from such practitioners. Branwell Brontë’s family consulted physicians and surgeons who would have blanched at being compared to J. L. Curtis, and noted down the names of nostrums supplied by irregulars in a medical encyclopedia that those physicians and surgeons would have considered the epitome of propriety.Footnote ¹⁰⁴

In the first decades of the Victorian period, the market for cheap medical print expanded rapidly. The publishing and advertising practices explored in this and the previous chapter challenged regular medical authority in different ways, though the fact that consulting surgeons identified as medical practitioners and competed with regular practitioners for patients meant that regular practitioners perceived them as much more of a problem. As the next chapter emphasizes, they were particularly threatening to regular practitioners because the identity of regular medical practice was unstable, and the differences between its print culture and those that this book has examined thus far were even more ambiguous than I have suggested. Even as the text of regular practitioners’ books and articles overlapped with pornographers’ and irregulars’ publications, so, too, did their publishing and advertising practices. As a new kind of publisher, the specialist medical publisher, entered the book business and looked to the medical profession to cultivate authors and readers, he found himself having to navigate an environment thick with suspicion of medical books, authors, and publishers, and ever-fearful of misidentification.