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In their efforts to control the practice of medicine, mid-Victorian era British doctors joined forces with anti-vice campaigners to censor publications about sex, reproduction, and sexual health. The doctors were targeting what they called “obscene quackery.” In the process, they helped create a censorship regime that affected what they themselves could publish about sexual health.

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Scholar Sarah Bull details how the 1868 case Regina v. Hicklinwould be used to police the distribution of medical knowledge well into the twentieth century.”

Although Hicklin concerned an allegedly obscene religious pamphlet, the test of obscenity codified in the decision was applicable wherever censors chose to use it. That test was, in the words of Justice Cockburn, “whether the tendency of the matter charged is to deprave and corrupt those whose minds are open to such immoral influences, and into whose hands a publication of this sort may fall.” The decision, Bull adds, “also deemed the intentions and qualifications of its producers immaterial.”

After Hicklin, any work “containing sexual details” was open to prosecution in Britain and other, ultimately, other English-speaking countries, including the United States.

British MDs had been campaigning in the years before Hicklin against public anatomy museums, alternative forms of healing, “irregular” or non-credential practitioners, and the “unruly trade in medical print.” The latter had seen an explosion of publications concerning pregnancy, contraception, “reproductive anatomy and physiology, venereal disease, and sexual debility.” Such works were readily affordable for middle-class readers in the 1840s. By the 1860s, these publications were well within reach of working-class readers. People could order such publications discreetly through the mail or buy them on the street. Commercial medical dealers who sold them also often hawked more lucrative patent medicines and personal consultations on the side.

Some of these publications, especially those produced by publishers on London’s Holywell Street, were frankly erotica or “proto-pornographic.” (Holywell Street was known as a place to buy French letters, not belles lettres.) This gave the “anti-quackery” campaign led by the medical journal The Lancet the opportunity to conflate quackery and obscenity. Forces like the Society for the Suppression of Vice, which was working to “protect” the public—especially women, children, and the working class—from “immoral literature” thus found an ally in the medical profession.

Who, however, was to determine what information about sexual health was salacious or immoral? For some, it would always be. Before Hicklin, writes Bull, “The dividing line between respectable and supposedly obscene methods of print promotion and distribution was exceedingly blurry.” After Hicklin, “even eminent medical authors [were] hesitant to write on sexual matters.” Actual cases of prosecution were relatively rare, because doctors and publishers learned to censor themselves.

“The rising number of disclaimers about the necessity of mentioning sex in medical publications during the last third of the nineteenth century suggests the concerns about prosecution also influenced decisions about composition, editing, and distribution,” Bull notes, “as authors and publishers felt compelled to anticipate and diffuse objections to their work.”

One example of authorities prosecuting a medical treatise as obscene was the case of Havelock Ellis’s Sexual Inversion in 1897. Ellis’s study was one of the first sympathetic approaches to what would soon be called homosexuality. An English physician and social reformer, Ellis originally wrote the work in German and published it in Germany. It was the English translation by Ellis and John Addington Symonds that caused the scandal, via prosecution of a bookseller who sold the volume to an undercover policeman. The remaining six volumes of Ellis’s pioneering Studies in the Psychology of Sex would end up being published in the United States. But they could only be sold to members of the medical profession until 1935, when the publication rights were taken over by Random House following a decision by the Southern District of New York that found James Joyce’s Ulysses was not obscene. That decision paved the way for the dissemination of Studies in the Psychology of Sex outside the medical environment.

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Bulletin of the History of Medicine, Vol. 91, No. 4 (Winter 2017), pp. 713–743
The Johns Hopkins University Press
The Virginia Quarterly Review, Vol. 16, No. 2 (Spring 1940), pp. 175–189
University of Virginia