We are more than happy to share our first guest essay on our blog. ELBOW project’s researchers held a course at the University of Helsinki in autumn 2024. Sigrid Autio was one of the students who took part to the course, and whose course essay we are more than happy to publish on the ELBOW blog.

The course, named Medical electricity, experience, and 18th-century history of science, explored many themes essential to our ELBOW project. In her essay, Sigrid explores patients’ cases reported in surgeon Miles Partington’s letters sent to another surgeon John Fell in the late 18th century.

In the essay, Sigrid considers how the social conventions regarding decency and social etiquette were affected by gender and social class, and how this was visible in situations where patients were treated on/near their genitalia, reproductive organs, or anus. She also pays attention to the influence that the reputation of medical electricity had on the behaviour of practitioners.

Enjoy the insightful essay!

Social Opinions on Modesty as Seen Through Miles Partington’s Letters in the 1780s England

Author:

Sigrid Autio, Bachelor’s student in History, University of Helsinki

Author bio:

At the time of publishing this essay, Sigrid Autio is halfway through her third year of studying history at the University of Helsinki. She is currently working on her Bachelor’s thesis, which explores the late 19th-century Swedish nationalism and its influences on archaeology and academia. In future, she would like to continue doing historical research.

Introduction

The Miscellanea Electrica was a notebook kept by surgeon John Fell in England between 1783–1802. The notebook was Fell’s while he was learning to use medical electricity, and it includes bookkeeping, patient cases, descriptions of experiments, letters from other medical practitioners and more.

My primary focus, however, is not on John Fell, but on the patients’ cases in the letters sent to him by another surgeon, Miles Partington, though some Fell’s cases will be used for comparison.

In this essay, I examine which social opinions regarding decency, privacy, and social etiquette are demonstrated in the patient cases. I am mainly interested in what is regarded as appropriate and decent, and how those opinions manifested themselves in Partington’s letters.

I have specifically selected cases where patients were treated on/near their genitalia, reproductive organs, or anus, in the hope that those cases would provide an inroad to examine ideas surrounding modesty and privacy. Then, I discuss the importance of socially accepted behaviour and proper conduct in a medical setting, as I ponder whether the relationship between patient and medical practitioner was affected by gender and social class.

This essay is an attempt to deconstruct some of the possible functions of social convention in a medical setting.

For the convenience of the patients

Surgeon John Fell, to whom the notebook belonged, started to experiment with medical electricity sometime in the 1780s, in the middle of his career. Surgeon Miles Partington also specialised in medical electricity, and is described by Fell as a “celebrated medical electrician & a gentleman”. According to Paola Bertucci, Partington was one of the few medical electricians who became quite well known in his time, and his business operating in Cavendish Square in London was very successful.

Whilst reading the letters from Partington, one particular detail caught my interest. In a letter written on 17 January 1786, Partington described how he usually treated menstrual obstruction using electricity: You will immediately perceive that this Apparatus is of no other Use than for the Convenience of the Patients, who attend at my House, where I am obliged to comply with opinions of delicacy.

In the letter, Partington described a procedure performed on a (female) patient’s pubis, and it is quite evident that the operation was deemed private and it needed to be dealt with in a delicate manner. It seems that there were certain social expectations that medical practitioners felt they were expected to respect.

Soile Ylivuori describes the British politeness-culture as the “privileged discourse addressing and defining social limits to propriety and acceptable conduct”. Much of the polite moral and social conduct was especially a virtue of the upper class, and it served to enforce class distinctions.

In late 18^th– and early 19^th-century Britain, a certain concern with manners, proper conduct, and social etiquette could not only be observed among the upper social circles, but also amid the upper middle classes. Social norms and expectations were something that penetrated every social interaction, including those between a patient and a medical practitioner. Partington makes it clear that the expectation of modesty and decency was something he was required to adhere to.

Operations through clothing in a delicate manner

Miles Partington’s letters were written at a time when medicine was not yet standardised or legally regulated, and medical professionals were not seen as “all-knowing authorities”. The lack of legal regulation was clearly demonstrated in Partington’s choice of words.

He did not write about set rules of practice, but about opinions of delicacy. There was seemingly a social agreement Partington referred to: the need to adhere to social norms was not legally required but socially expected.

In a letter written on 16 November 1785, Partington described how he treated obstructions of ”catamania” (menstrual cycle) along with other internal diseases. In the description he stated very clearly that the operations “on the uterus” were performed through the patient’s clothes.

He wrote: I press the Ball against the Cloaths of the Patient and over the Part that is to be electrified that is as near the seat of the Disease as can conveniently and delicately be done.

He went on to say that in most cases regarding menstrual obstruction, electrifying the bottom of the spine close to the sacrum and coccyx was generally successful. In this case, he made the same remark regarding delicacy as earlier – he did not treat the patient directly in the uterus/vagina, but in a location near the area.

In the letter from January 1786, Partington wrote that he drew sparks of the pubes but without having any direct passage of electricity through the uterus. It is possible that this was done for the sake of the patient’s comfort, or because it was not regarded as medically necessary. However, I argue that modesty was taken into consideration in the choice of method.

I suggest that the reason for doing the operations in this manner, and for clearly stating it in his letters, was because Partington deemed it inappropriate for a practitioner to see, touch, or treat a naked female body, unless it was absolutely necessary.

Electrical shocks for menstrual obstructions reproductive organs

I interpret the choice of phrasing, conveniently and delicately, as revealing to the fact that performing the operation through the clothes was partially a choice based on societal opinions of decency and modesty. It is worth noting that other electrical treatments performed on non-genitals were also occasionally administered through clothing.

In another letter from January 1786, Partington wrote about the preparing an electrification for treating menstrual obstructions: My common Mode in this Case is, to insulate the Patient, an charge the great Jar in a small Degree, merely for the Purpose of performing the Operation without a Servant in the Room”.

As far as I can tell, having the servant to leave the room was not something Partington described in any other case. The procedure was evidently deemed very private, and thus having any unnecessary observer present as a spectator was improper, even though the operation was performed through the clothing.

Partington also described how the patient themself needed to hold certain parts of the machine and press a Glass-Handle-Director on the area that was to be electrified. This was probably partially a result of not having the servant to help, but it also allowed the patient to have some control over the procedure. It created a situation where the patient did not have to be touched by another person, Partington himself included, in a very private area. At the same time, the method also served to prove that the patient was participating willingly.

John Fell, in his part, documented two patient cases where he treated women with issues regarding their reproductive organs. One of the cases was an account of a woman paralysed after childbirth whom Fell cured by electrical shocks to the spine and bottom of sacrum. He mentioned that the shocks were administered through a fold of linen so that the conductor would not be in direct contact with the skin, but he did not note why he did so. In the second case Fell described curing a young woman in a similar manner, but without giving any explicit indication of feeling the need to adhere to social expectations of decency.

It is difficult to tell based solely on this source material why Partington made these remarks regarding decency, and why they were missing from Fell’s cases. The most likely explanation might be that Fell might not have intended the notebook to be read.

Comparing male and female patients’ cases

One might speculate whether there is a gender factor to be considered: was it more important for Partington to take modesty into consideration when his patient was female?

Unfortunately the number of patient cases from Partington is limited, and thus comparing cases in a fair manner becomes tricky. However, there are a few cases where Partington described using electricity to treat diseases in male genitalia, so at least some comparison can be made.

In one exemplary case, Partington treated a 60-year-old gentleman’s prolapsed anus with electric sparks, without specifying whether the operation was performed through clothing or not. Immediately following this description, he stated: I am always glad to have an Opportunity of trying Electricity upon internal Cavities.

As in other male patients’ cases, Partington made no direct comment on delicacy or discretion, at least not as explicitly as with the female patients. He also described treating a man with gonorrhoea and two men with spasms in the perineum. In the latter cases he did include that the operations were performed through the patients’ clothes.

The fact that Partington did not seem to be as conscientious in explaining the procedures performed on male patients is in itself revealing. Partington wrote in a more straightforward manner when discussing, for example, the gentleman’s prolapsed anus.

So, we might still draw some kind of conclusion based on the details included and those left out. Partington did not seem to feel the need to explain how he complied with social expectations of decency with male patients in the way he did with female patients. Even though John Fell specifically requested Partington to write about menstrual obstruction, and thus it is reasonable for those descriptions to be more detailed, I still believe that my point has validity.

Following the etiquette and medical ethics

Social structures can be described as performed phenomena, behaviour that must be acted out continuously. Marjorie Morgan writes, “Behavioural literature and code suggests that English men and women viewed manners and morals as crucially important agents of social stability”. The manuals on etiquette, such as A System of Etiquette by Dr. John Trusler (1805), were clear indications of the importance placed on proper behaviour.

Efforts to create more of a consensus or standardisation within the legally unregulated medical field were made. For example, Thomas Percival wrote in his manual Medical Ethics (1803) that a practitioner should always try to give his patients some privacy. He also made a specific comment regarding female patients: And females shall always be treated with the most scrupulous delicacy. To neglect their feelings is cruel, and an insensibility to modesty and virtue.

The sentence seems to reflect the generally held ideas regarding privacy, decency, and delicacy, while providing a parallel to what Partington seems to think about modesty. Both Percival and Partington seem to have been quite aware of how the dynamic changed when the patient was a woman.

Not only for the sake of the patient, but for Partington’s own reputation as a gentleman, it might have been important to behave in a way as not to jeopardise his patients’, or his own, performance of decency and delicacy. Judging from the letters, it seems that Partington felt that there were more complicated social expectations that had to be respected when dealing with women.

The function of social conventions

Partington practiced medicine at a time when medicine was not yet standardised or legally regulated, and medical professionals were not seen as “all-knowing authorities” whose advice one should trust without question. It seems that there was a fair amount of mistrust between patients and physicians, and something that Rosa Dale-Moore argues that had to do with the power dynamic caused by differences in socio-economic background and education, as well as factors like gender.

Another possible cause of mistrust, specifically regarding medical electricity, was a general reluctance towards electricity, a force known to be lethal in large amounts.

I suggest that the lack of legal regulation and the general mistrust towards medical treatment were some of the reasons for the importance placed on socially acceptable conduct in medical treatment. The social interaction between a patient and a practitioner was regulated on the same terms as the other social relationships, and the commonly understood social rules were reflected in the medical practice.

Paola Bertucci describes how some of the mistrust was overcome by the fact that patients knew the practitioners. It is also worth noting that social etiquette, and shared understandings of behaviour must have been a source of comfort in a space that was intimidating.

Considering all this, one might assume that medical professionals adhering to the etiquette of the upper classes became important – for the comfort of patients, possibly for the success of the business, and for the reputation of the practitioner.

Another reason for the importance of adhering to societal expectation might have been that surgeons like Partington tried to make medical electricity more widely accepted as a legitimate treatment, especially among the formally trained physicians who often disregarded the medical use of electricity. But perhaps most importantly, socially accepted behaviour and acting in a respectful and considerate manner was what was expected. The culturally bound social structures formed the framework for all social interactions.

Conclusions

It is clear that surgeon and medical electrician Miles Partington felt that there were certain societal opinions regarding modesty, privacy, and decency that had to be respected even in a medical setting.

Generally it seems that he was more aware of the social convention when it came to female patients. I suggest that the lack of legal regulations and standardisation within the field, and a general mistrust towards medical treatment were contributing factors of the importance placed on adhering to social norms. Social behaviour was conditioned by factors like gender and class. It also provided stability and comfort, especially in an intimidating space. Adhering to social code was a general expectation and could not easily be ignored.

Partington adhering to societal expectations was something that was expected by his patients. What is interesting is how those social expectations were dealt with in a situation where patients needed to receive treatment in private areas in their bodies.

Partington’s letters provide an interesting case study of the ideas and practices at the time, as well as demonstrating how social structures were performed.

Sources:

Wellcome Collection: Miscellanea Electrica. 1783-1802. Reference:MS.1175.

Percival, Thomas: Medical Ethics. Volume 259. 1803.

Trusler, John: A System of Etiquette. Second edition, with additions. Printed by M, GYK, Market-Place. 1805.

Literature:

Bertucci, Paola: ”The Uses of Humans in Experiment, chapter 4: Shocking Subjects: Human Experiments and the Material Culture of Medical Electricity in Eighteenth-Century England”. In The Uses of Humans in Experiment (edited by Erika Dyck & Larry Stewart, Clio Medica series, Vol. 95). 2016.

Dale-Moore, Rosa: Healing Powers; An Examination of Medical Ethics, Benevolent Lies, and The Doctor-Patient Relationship in Late Eighteenth-Century Britain. University of Puget Sound Honors Thesis. 2016.

Jucker, Andreas: ”Conduct politeness versus etiquette politeness: a terminological distinction”. In Journal of Politeness Research, Vol. 20, Nr. 1, p. 87-109. 2024.

McCullough, Laurence; Coverdale, John & Chervenak, Frank: ”Trustworthiness and Professionalism in Academic Medicine”. In Academic Medicine, Vol. 95, Nr. 6, p. 828-832. 2020.

Morgan, Marjorie: Manners, Morals and Class in England, 1774-1858. Macmillan Press. 1994.

Roberts, Laura Weiss: ”High Road, Low Road: Professionalism, Trust, and Medical Education”. In Academic Medicine, Vol. 95, Nr. 6, p. 817–818. 2020.

Silverman, Barry D.: ”Physician Behavior and Bedside Manners: The Influence of William Osler and the Johns Hopkins School of Medicine”. In Baylor University Medical Center Proceedings, Vol. 25, Nr. 1, p. 58–61. 2012.

Ylivuori, Soile: ”Rethinking Female Chastity and Gentlewomen’s Honour in Eighteenth-Century England”. In The Historical Journal, Vol. 59, Nr. 1, p. 71–97. 2016.