INTRODUCTION: THE MEDICAL TRADE CATALOGUE IN CONTEXT

With the publication of The Treatment of Poisoning in 1888, Robert Saundby, Professor of Medicine at the University of Birmingham, and Philip Harris & Co. Ltd, a Birmingham-based pharmaceutical and medical instrument manufacturer, revealed the results of their long and fruitful business partnership.1 True to its name, the booklet aimed to instruct medical professionals in suitable treatments for cases of poisoning and yet its collaborative authorship, between an elite physician and a medical trade company, meant that it was neither solely a medical work of reference nor an advertising pamphlet. While outlining Saundbys extensive research findings on effective antidotes, the publication also functioned as a sixteen-page endorsement of Harriss pharmaceutical products and formed a part of the companys growing advertising output. More broadly, The Treatment of Poisoning was one edition among many thousands in an increasingly prevalent genre of publication: the medical trade catalogue. It is the purpose of this book to explore the rise and development of the medical trade catalogue in late nineteenth- and early twentieth-century Britain. The medical trade catalogue, a book-like publication of between 10 and 1,000 pages, was one of the most prominent forms of advertising aimed at medical professionals in this era. With circulation figures reaching 30,000 copies per edition by 1914, the catalogue was employed by medical companies across the country and beyond to provide medical practitioners with a comprehensive promotional guide to medical instruments, pharmaceuticals and appliances (see Figures I.1. and I.2). Yet, practitioners were also invaluable to its development. Like many of his colleagues, Saundby was a regular reader of and contributor to this form of publication. Saundby and countless other medical practitioners provided many valuable suggestions to catalogue producers aimed at improving the publications product layout, text and illustrations; they also directly provided content by writing instructive text based on their research, by providing product endorsements for tools they had tried and tested and by promoting their own eponymous designs of new medical tools and appliances.2

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Figure I.1: The exterior of John Weiss & Son Ltd, Illustrated Catalogue of Surgical Instruments and Appliances ([n.p.], 1901). By the late nineteenth century, medical instrument makers shaped their catalogues into well-presented, hardbound books. Reproduced courtesy of Thackray Medical Museum, Leeds.

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Figure I.2: The interior of Lynch & Co., Ltd, Price List of Druggists Sundries, Surgical Instruments ([n.p.], 1905), pp. 2689. Reproduced courtesy of Thackray Medical Museum, Leeds.

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While regularly interacting with catalogues (especially those produced by Harris), Saundby simultaneously condemned practitioner involvement in general commercial activity, particularly in product promotion. As secretary of the British Medical Association, Saundby was a stalwart of medical professionalism and his Medical Ethics of 1902, a practical guide to professional standards of best practice, stated in no uncertain terms that: No registered practitioner ought to be personally connected with any business that manufactures or deals in any article of invalid dietary or drug, or medical or surgical instrument.3 In the absence of any formal ethical codes of conduct, Medical Ethics was Saundbys attempt at discouraging doctors from damaging their own reputation and the reputation of their profession in the eyes of the public through partnerships with tradesmen. Such collaborations were undoubtedly a growing temptation for medics who wished to earn a more comfortable living in an increasingly competitive profession. The popularity of Saundbys guide among the medical readership suggests practitioners took this advice seriously; it certainly laid the foundation for the medico-ethical work of the British Medical Association after Saundbys death in 1918.4 Crucially, Medical Ethics made no mention of medical trade catalogues. Such an omission was perhaps unsurprising given Saundbys contribution to The Treatment of Poisoning, but far from questioning his respectability or the respectability of other practitioner-contributors, the publication was a response to the increasing commercialization of medicine and broader trends in economic growth, mass production and household consumption. Indeed, while professional regularity bodies fiercely condemned doctors prescription and endorsement of the goods of countless flourishing patent and proprietary medicine vendors and electro-medical equipment suppliers, neither Saundby nor any other catalogue contributor met with hostility from the profession. By 1900, the General Medical Council, established following the 1858 Medical Act to uphold standards of best practice, had struck off approximately thirty British practitioners for endorsing some form of medical product in public prints and cautioned many more.5 Yet, no practitioner contributing to the catalogue was charged with professional misconduct and no complaints or debates about practitioners contributions appeared in the medical press, as they did so frequently regarding publications intended for general consumption. What then allowed the medical profession to accept its members involvement in advertising in the medical trade catalogue, when it so forcefully condemned their involvement in other forms of product promotion? The Medical Trade Catalogue seeks to explore this important yet neglected aspect of medical practitioners experience by examining how and why the apparent conflict between practitioners and industry simply did not apply to the medical trade catalogue as it did to other forms of advertising and commercial activity. It demonstrates that the profession accepted practitioners interactions with the publication because catalogue producers the producers of pharmaceuticals and medical tools dis-

Introduction

tinguished it from all other forms of advertising in two main ways: by targeting only qualified medical practitioners to the exclusion of lay consumers and by shaping the catalogue into a publication with the same physical elements as (and a similar content to) a medical reference book, an informative and educational publication the profession embraced. To some, this might seem a strange endeavour. The sceptic might ask: how much can one specialized form of print tell us about medicine? But this focus on the catalogue not only tells us about its design, production, distribution and reading as a significant medical publication of this period; it also signals doctors broader interactions with trade and material goods. In particular, it informs our understanding of the role of practitioners in the design of medical tools and their power in purchasing such tools. The catalogue was an effective mediator between the seemingly incompatible worlds of commerce and medical professionalism; it allowed practitioners to balance their professional commitments with the rising consumerism that seemed to dominate everyday life in late nineteenth- and early twentieth-century Britain. The medical trade catalogue as both advertising and reference material achieved a unique hybrid status within the profession, not just in Britain but also globally as markets for medical tools and pharmaceuticals expanded. The Medical Trade Catalogue is therefore a book about late nineteenth- and early twentieth-century British medical practice, a study of what being a doctor involved and an outline of the ways in which medical professionals worked with companies to mutual benefit. Indeed, trade was not solely constituted by patent medicine and medical appliance vendors aimed at popular audiences, as most existing studies seemingly suggest, but also included elements which complemented medicines drive for scientific progress and professionalism. Professional medicine during this period was not solely a clinical art or a practical science but was also an industry that sought promotion and the generation of profits. Doctors played a key role in this industry as both consumers and promoters of medical products and crucially this role complemented, rather than conflicted, with their professional sensibilities. Such discussions have clear resonances in current medical practice and the relationships between medical practitioners and suppliers that developed in this period continue to thrive today. By focusing on this particular form of publication, The Medical Trade Catalogue enhances three main bodies of historical scholarship. The first of these, the history of medicine, analyses the development of the medical profession and its interaction with the world of commerce. The second, the history of technology, is concerned with the pharmaceuticals, tools and appliances which formed the commercial content of the catalogues, but is also interested in practitioners as users and consumers. The final body of scholarship, once dominated by historians of the book but now extended into other fields (not least the history of science), focuses on the culture of print and its significance within a given readership.

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The Medical Trade Catalogue in Britain, 18701914

Medical Professionalism and Commerce

Within the history of medicine, mid-nineteenth-century professionalization has been a subject of much attention. While there is little need to discuss the extensive literature in detail here, it is worth briefly outlining how The Medical Trade Catalogue defines medical professionalism in this period. Paul Starrs The Social Transformation of American Medicine is particularly helpful.6 Starr understands the distinctive competence of the profession in three main ways: cognitive, moral and collegial. Like American practitioners, British doctors at this time could be distinguished by their possession and demonstration of medical knowledge, education, training and expertise; through their adherence to certain ethical codes of practice, including those surrounding advertising and medical commerce; and through their collective participation and commitment to ensuring the competence of the professions members. Many have gone on to augment Starrs definition but it perhaps remains the most comprehensive for the British context. In recent years, scholars within the history of medicine have also looked beyond abstract definitions of the profession in order to explore medical practice. A growing body of scholarship on medical commerce, a part of medical practice of particular relevance here, has now converged with the literature on professionalism resulting in a much more comprehensive understanding of late nineteenth- and early twentieth-century medicine as both a profession and a trade. Purely sociological perspectives of the medical profession, which once dominated the historiography and concerned itself with legislation, institutional foundation and educational qualifications, thus gave way to more inclusive studies by historians such as Anne Digby, Irvine Loudon and Jeanne Peterson, who recognized that professional medicine consisted of more than just doctors mission to attain a static set of essential criteria.7 Medicine, these historians argued, also incorporated the economic reality with which practitioners were faced: their need to make a medical living and their regular interaction with the commercial world. Accordingly, the medical marketplace as a key conceptual framework has become dominant in discussions of medical commerce. Discussions of the marketplace have largely taken two forms, neither of which adequately foregrounds the doctor as a producer or consumer of medical products. During its first inception in the mid-1980s, historians, such as Roy Porter, initially used the term as a metaphor to represent the provision and consumption of health-care services in seventeenth- and eighteenth- century England.8 In turn, this model enriched the new economic perspective of late nineteenth- and early twentieth-century professional medicine, which likewise focused on practitioners as suppliers of medical services to patients in a metaphorical, rather than physical, marketplace. New formally acquired professional status, advocates of this model argued, offered practitioners a fairer system, albeit an increasingly competitive

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Introduction

and restrictive one, in which to sell their services. Concerns over respectability and identity formed a significant part of this new economic approach. In Making a Medical Living, Anne Digby, for example, highlights that the professions concern with respectability led to its condemnation of practitioners advertising their services to patients, fearful of its association with irregular practitioners or those of a lower status such as chemists and conscious of its ability to cause unfair advantage over other practitioners.9 Scholars have also used the medical marketplace to explore the production and consumption of medical products among lay rather than professional audiences. Late nineteenth- and early twentieth-century general consumers with rising disposable incomes formed a willing market for all manner of growing numbers of cure-all patent medicines, elixirs, lotions, pills, electro-medical devices and contraceptive appliances; consumption, which often took place in a physical marketplace, was aided by an unprecedented growth in the output and variety of promotional material, including newspapers and journals. Studies by Peter Bartrip, Lori Loeb and Takahiro Ueyama have typically highlighted the tensions between the rising general consumption of medical products and medical practitioners, who, following the 1858 Medical Act in particular, deemed any products not professionally sanctioned as dangerous or useless in order to protect their patients and assert a monopoly over medical practice.10 Practitioners who chose to sanction, purchase or prescribe unorthodox products rejected professional ethical standards and could face professional exile. Historical literature on both the profession and on the medical marketplace, then, accepts that doctors pursuit of a more commercial approach to medicine could be problematic. Yet, this literature has largely neglected the professionals role in producing and consuming the tools and pharmaceuticals vital for medical practice. Instead, consideration of professional consumption, of pharmaceuticals in particular, is a topic increasingly pursued by business historians. Those who have adopted this approach Roy Church and E. M. Tansey, Geoffrey Tweedale and Jonathan Liebenau, for example have highlighted the potential tensions between commerce and professionalism by recognizing the significance of the marketing developments of renowned British pharmaceutical manufacturers, such as Allen & Hanburys and Burroughs, Wellcome & Co.11 For example, Burroughs, Wellcome & Co. aimed to distance its print-based advertising of ethical medicines to medical professionals from its general advertising of proprietary drugs to lay consumers. Companies employment of the trade catalogue in aiding this distinction has only received cursory attention, but this form of print, along with the employment of the travelling salesman and exhibits at world fairs and medical conferences, allowed companies to effectively market their so-called ethical products to doctors. Much work, however, still needs to be conducted on the doctors role in consuming, as well as producing, medical and surgical

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Medical Technologies, Information Technologies

instruments and, with the exception of James Edmonsons comprehensive study of the surgical instrument trade in North America, this remains a chronically neglected area in business history and the history of medicine.12 The Medical Trade Catalogue, however, foregrounds the practitioner in tool consumption and production through its primary focus on print. The Medical Trade Catalogue is therefore intended to address the relative absence of the medical practitioner in both consuming and producing products particularly medical tools and surgical instruments in the history of medicine and business history scholarship. Existing studies of the late nineteenth- and early twentieth-century medical marketplace, which focus on tensions (between practitioners, between practitioners and patients, or between practitioners and companies), are here extended to include an assessment of practitioners unproblematic contribution to the medical trade catalogue and their acceptable role as producers, alongside industry, and as consumers of medical goods. However, recent growing criticism suggests that the medical marketplace concept may be outdated, not least because of the potential confusion between metaphorical and physical marketplaces. Moreover, as Mark Jenner and Patrick Wallis remind us in a recent contribution to the field, medicine was not formed of only one market, or marketplace, but many overlapping markets.13 Here then, market, or more appropriately markets, is employed to aid our visualization of the variety of transactions of medical goods and services among a broad array of producers and consumers simultaneously taking place. Of course, the limits of medical professional markets are difficult to determine, particularly in this period of professional consolidation. Growing numbers of institutions employing professionally-related purchasers (such as nursing homes) that required uniforms, sanitary appliances and sterilizable storage facilities were also additional consumers for medical companies to target, thus further blurring market boundaries. Yet, given the almost endless possible number of transactions between producers and an exhaustive variety of professionally-related consumers, this study necessarily restricts its analysis to physicians; surgeons, including specialists, such as dentists; and general practitioners employed in an array of areas, from asylums to private insurance firms; and their increasing requirement for tools, drugs and specialist forms of print.

In assessing both the supply and demand of medical products and services, business histories and studies in the history of medicine also have much in common with those in the history of technology, which view medical tools and appliances in terms of production and use. Although medical tools, appliances and pharmaceuticals in themselves are not the primary focus here, the ways in which

Introduction

companies promoted such technologies within the catalogue and the ways in which practitioners as users of technologies shaped the catalogue, forms an important part of The Medical Trade Catalogue in three main ways. First, in revealing the coexistence of markets for both new and older medical technologies, this assessment of the pages of the medical trade catalogue reemphasizes the importance of demand-led innovation and the persistence of existing technologies long after new innovations are introduced. Such findings inevitably challenge studies which still focus solely on supplier-led innovation, and thus appear to present unproblematic acceptance of new technologies among given markets of consumers. For example, James Edmonson and John Kirkup, both of whom work with medical artefacts, characterize the rise of aseptic surgical instruments between 1886 and 1893 as an aseptic revolution.14 Their interpretation suggests that practitioners unproblematically and instantly replaced their non-aseptic tools with new aseptic designs, which is undermined through our focus here on the catalogue. Second, The Medical Trade Catalogue expands existing studies that identify the significance of medical technologies to burgeoning medical specialisms. Much has been written about the emergence of the late nineteenth-century medical specialist, the rise of the specialist hospital and the adoption of accompanying technologies to conduct new specialist practices as a political move for professional consolidation. Christopher Lawrence, Stanley Reiser, George Rosen and George Weisz, for example, have argued that medical specialists of this period, in areas such as ophthalmology and orthopaedics, were more likely to show an appreciation of new scientific insights of the late nineteenth century and to adopt new technologies as a way of challenging the power and privilege of the established elite physicians.15 The Medical Trade Catalogue thus considers the role of the publication in medico-political debates, particularly the drive for the recognition of specialisms among markets of practitioners, rather than the technologies themselves. As we will see, companies producing specialist tools, such as Claudius Ash & Sons, dental instrument manufacturer of London, aided specialists call for wider professional changes by shaping their catalogues into medical reference books and disseminating notions about specialization. Finally, by viewing the medical trade catalogue as more than an adjunct to the tools and pharmaceuticals it promoted, The Medical Trade Catalogue expands our very definition of a medical technology. Indeed, as many recent studies acknowledge, the technologies of medicine include more than the drugs and devices that once dominated the historiography, and cover both material and non-material innovations, systems of practices and organizations.16 The medical trade catalogue is clearly not a diagnostic or therapeutic tool, but it is a material innovation, one rarely seen as more than a source of reference by the museum curators who have long used it to identify and date the medical instru-

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Medical Print Culture

ments within its pages.17 Yet, the catalogue, like other technologies, was shaped by both producers and end-consumers, and its form and purpose its two most essential dimensions were continually negotiated between the two; the form, embodying function, was reconfigured as the purpose changed. More specifically, the medical trade catalogue is a communication or an information technology designed and produced to extend medical instrument makers capacity to sell products. While there has been an array of historical studies on other functional forms of print aimed at guiding readers through everyday life, such as nineteenth-century train timetables, discussions of catalogues in this role have been limited.18 Less than a handful of studies currently explore the history of catalogues within specialist trades, although Paulo Brennis brief analysis of scientific instrument catalogues is useful for comparative purposes.19 A few more studies, however, have outlined the significance of the retail mail-order catalogue as a communication technology. In The Control Revolution, James R. Beniger, for example, argues that the first catalogues produced by American retail giant Sears, Roebuck & Co. in the late nineteenth century, were material innovations crucial for the dissemination of particular forms of knowledge to householders following modern industrialization, alongside other forms of print and non-printed innovations, such as telegraphy.20 The modern rise of the medical trade catalogue as a communication technology, as we will see here, resulted from manufacturers aim to control markets: as all manner of new machines, technologies and techniques rapidly increased, so did the need for market control via information contained within suitable formats.

While printed communication technologies are currently receiving an increasing amount of attention from historians of technology, they have long been studied by historians of print culture. Studies of late Victorian and Edwardian advertising, for example, commonly highlight novel rhetorical features, such as increasing numbers of sentimental images aimed to appeal to new markets of upper- and middle-class female consumers and, as we will see here, rhetorical features also apparent in the catalogue in a form aimed to appeal to medical professionals.21 Yet, by focusing on a publication in book form, albeit one non-literary in content, this study more significantly contributes to a well-established analytic bibliographic approach in the history of the book. In particular, it enhances our understanding of the print culture of the history of medicine, a chronically understudied part of a thriving field of print culture within the history of science; it does so by going beyond the changing physical means of print production. Recent scholarship at the nexus of print culture and the history of science has analysed the physical features of a book, its paratext and circulation from

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producer, publisher, distributer to consumer and back to producer in the form of consumer responses, within what Robert Darnton has defined as a communication circuit.22 Analysing these elements in the life cycle of forms of print can reveal as much about a publications meaning within a given market as the text itself and the printing technologies used to produce it. Indeed, the once-common printing history, which for late nineteenth and early twentieth centuries tended to emphasize the introduction of rolled paper, electro-stereotyping and the mass production of books by factory-based printing firms, has now been extended to take in account the market for reading. Recent interest in reading, then, demonstrates a shift in historical study from the what and the who to the how, the where and the why and highlights how book producers with commercial motivations carved out reading audiences with suitably shaped texts. Geoffrey Cantor et al., for example, have demonstrated that the British scientific periodical press witnessed enormous growth during the nineteenth century because the weekly or monthly journal was a much more accessible method of communication to an increasingly literate audience with a growing interest in scientific ideas.23 Similarly, Jonathan Topham has argued that The Bridgewater Treatises were prepared with wide margins, a large typeface and were produced to a high quality, in order to demonstrate their alignment with serious theological treatises, which circulated in markets formed of the aristocracy, gentry and the upper middle classes.24 In contrast, the general absence of detailed bibliographic analysis and explorations of how publications were shaped to suit readers in recent discussions of professional medical print culture in this period means that our understanding of the importance of print to medical practice is limited. Such neglect is all the more surprising, given the growing importance of authorship and reading to the nineteenth- and early twentieth-century medical professional, as outlined by Starr and others. Indeed, the catalogues book-like form, the methods used to publish it and practitioners use of it for reference material demonstrate that the publication had much in common with other understudied but widely prevalent medical reference books of the period. Reading is therefore as critical to The Medical Trade Catalogue as production: the publications changing material form its textual content, its illustrations and exterior covers aimed to both suit and shape the professional and practical requirements of a more distinguishable readership of medical practitioners, and as companies responded to economic changes and intensified competition within the medical trade. Robert Dartons communication circuit is of particular importance here and while it is not possible to rigidly analyse the catalogue at its every stage, the broad approach nevertheless highlights the ways in which meaning was embedded in the catalogues physical features as it circulated. Authors are also readers themselves and practitioner-readers of the catalogue complete the circuit because they influence companies both before and after the

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act of catalogue composition. In fact, as we will see, catalogue readers influenced producers much more directly than other types of publication through the contribution of content.

The Medical Trade Catalogue: New Perspectives

The Medical Trade Catalogue thus proposes a much needed broad historical argument about the commercial and material practices of late nineteenth- and early twentieth-century British medicine and, in doing so, is innovative in aligning current scholarship in the history of medicine, commerce, technology and print culture. Nonetheless, it remains a detailed case study of one particular form of print, a case study which assesses all known existing editions of the medical trade catalogue between 1870 and 1914 (a total of approximately 400 produced by 101 different companies). The largest collection of catalogues in Britain, and possibly the world, is held at the Thackray Medical Museum, Leeds, UK, but its extensive collection may reflect more about institutional policy than it does about the numbers originally produced.25 Collecting policies, along with the ephemeral nature of the publication, mean it is difficult to estimate how representative this sample is; it seems likely that many more editions were produced than we have knowledge of or access to. Yet, while it is not possible to identify how frequently many of the smaller companies in the trade produced the publication, catalogue prefaces suggest that the museum holds comprehensive runs of catalogues produced in successive years meaning that this sample includes at least one of each catalogue edition produced by Britains largest medical instrument makers. This study cannot therefore claim to be definitive, but it is certainly the most comprehensive study to date. The catalogues changing form and content serves to highlight how producers attempted to incorporate practitioners requirements following direct requests or company assessments of what they felt practitioners needed. Catalogue reading practices are perhaps more difficult to obtain than producers intentions. Indeed, there appears to be relatively few existing accounts of practitioner experiences of the publication, particularly among those beyond the elite. Catalogue producers intended for the publication, with its distinct promotional purpose, to fit neatly into the environment of everyday life by finding common cause with readers, and thus practitioners were less likely to record their experiences of the publication than they might for more sensational publications, such as The Vestiges of Creation, the anonymous Victorian publication eloquently analysed by James Secord.26 Yet, companies motivations and their increasing reliance on the catalogue as a promotional tool, and practitioners catalogue experiences, can be obtained by piecing evidence from the catalogues together with a range of sources: correspondence inserted inside individual catalogue

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editions, numerous medical company and printers records, hospital accounts, reviews in periodicals and from the physical markings practitioners left on or inside particular catalogues. By consulting a range of sources, The Medical Trade Catalogue thus provides a more comprehensive view of the relationship between medical commerce and professionalism than has hitherto been attempted. The Medical Trade Catalogue is comprised of six chapters. The first four of these chapters focus on catalogue production from generation to publishing to demonstrate companies intentions to create an advertising publication practitioners could accept, find useful and to which they could contribute. Following this introductory chapter, Chapter 1 broadly outlines the rise and development of the medical trade catalogue, from the first few editions produced in the late eighteenth century to the vast numbers of catalogues produced by the outbreak of the First World War. It considers the nineteenth-century expansion of the British economy, the growth of medical print culture and consumerism, and the professionalization of medicine as key factors in its rise and as explanations for the publications particular format. Chapters 2 and 3, meanwhile, focus in more depth on catalogue form and content between 1870 and 1914: Chapter 2 assesses the ways in which companies shaped typical catalogue features, such as textual content, illustrations and promotional devices such as branding and trademarks, in order to appeal to practitioners in four overlapping segments of the professional market (surgeons and physicians, apothecaries and chemists, medical specialists and general practitioners), while Chapter 3 assesses the significance of the ways in which companies sought to promote their goods within the catalogue. Chapter 3 focuses on three particular types of medical technologies promoted within the catalogue products associated with asepsis, anaesthetic inhalers and X-ray apparatus and in doing so, demonstrates that companies used similar forms of rhetoric novelty, safety, convenience and scientific progress for each type of product to appeal to practitioners. Contrasting somewhat with the previous chapter, Chapter 4 proceeds to explore the generation and production of a catalogue edition to demonstrate how companies and printers shaped the publication into the form of a medical reference book, through the inclusion of features such as the quality of paper and types of binding and blocking, in order to appeal to their target market of practitioners. The final two chapters focus on the reception of the catalogue among individual practitioners and the profession as a whole. Chapter 5 continues to examine the ways in which companies made their catalogue a publication exclusive to a professional practitioner audience by analysing the three main methods of catalogue distribution: via the postal service, travelling salesmen and through international trade exhibitions and medical conferences. Through an assessment of evidence contained within the customer registers of Maw, Son & Thompson/Son & Sons, a large London-based pharmaceutical and medical instrument

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manufacturer, it also demonstrates that companies succeeded in obtaining and maintaining custom for catalogues and the goods promoted within them from the medical elite. The final chapter completes the analysis of the life cycle of the catalogue by uncovering practitioners responses to and experiences of the publication. By outlining the main ways in which practitioners of high professional status read, used and actively contributed to the catalogue, it demonstrates that catalogues formed an important part of medical practitioners work-based routine, which, unlike practitioner involvement with advertising aimed at lay audiences, in no way contravened the ethics laid out by their profession. The Medical Trade Catalogue, then, offers a new and distinctive account of late nineteenth- and early twentieth-century British medical practice, one that places commerce and print culture at the heart of its analysis. It also offers implications for the ways in which we think about British medicine in the present. Medics today, as well as the National Health Service Trusts, (where they still exist), the hospitals and the universities of which they form a part, continue to form lucrative markets for all manner of pharmaceuticals and instruments, but also form growing markets for new forms of biomedical innovations, stem cells and genetic engineering, and are targeted by all manner of promotional techniques, including the sales catalogue. Medics form an elite body of professionals which cannot be divorced from the influence of commercial activities. Perhaps, then, there has never been a more appropriate time to look at the history of the medical professional as a specialist consumer, actively working with and contributing to the business world.