Middlemarch is one of the delights of English literature, set in 1832 at the time of the Land Reform Bill, when the railways were just being established, and the old life on the land was changing forever as the industrial revolution gathered steam. 

George Eliot’s has been called the finest of all the minds of the English novelists, and Middlemarch is widely considered her masterpiece. It is surpassed only, perhaps, by Tolstoy’s Anna Karenina for its faultless plot, by James Joyce’s Ulysses for its intellectual energy, and by Melville’s Moby Dick for its single-mindedness. 

Eliot is exquisite in her analysis of character, and her presentation of drawing room wit. In this she recalls the earlier Englishwoman Jane Austen. Her style is her own, and her sentences are to be savoured one by one, laughed at, marvelled at, repeated aloud. Remember if you read it that this book was written as a serial from 1871 to 1872, in the days before electronic media. There was plenty of time to enjoy reading, and so the book proceeds at a walking pace. Today her precision and incisiveness is seen as rather too correct. 

Middlemarch is of interest to us because one of the central characters is a doctor in this provincial town. Lydgate arrives with a head full of ambitious plans to direct a fever hospital and to do his own private physiological researches. He soon meets Lady Chettam:  

“For my own part, I like a medical man more on a footing with the servants; they are often all the cleverer”  she says, and George Eliot tells us that ‘Mr Lydgate had the medical accomplishment of looking perfectly grave whatever nonsense was talked to him’ – so she formed ‘the most cordial opinion of his talents’. 

Lydgate is a young man in control of his world, and has no ambition to get caught up with family life: 

‘Plain women he regarded as he did the other severe facts of life, to be faced with philosophy and investigated by science.’

The depth and variety of Eliot’s female characters mark her out as a sort of proto- feminist: a formidable intellect made more so by the prejudice of her time toward the female mind, which was believed to have restricted capacities in many fields. Eliot examines either side of the gender debate with typical wit. From the masculine point of view she notes that ‘A woman dictates before marriage in order that she may have an appetite for submission afterwards.’ From the opposing camp comes the desire for ‘a man of talent, whom it would be especially delightful to enslave.’ 

Lydgate, like many another  young professional, is soon enamoured of Rosamund Vincy, a social beauty  without affection or much of her own intellect. Later in the book he must come to terms with her shallow social vanity and manipulative emotional behaviour.  Eliot’s description of Rosamund is wonderfully cutting:

'Certainly, small feet and perfectly turned shoulders aid the impression of refined manners, and the right thing said seems quite astonishingly right when it is accompanied with exquisite curves of lip and eyelid.  And Rosamund could say the right thing; for she was clever with that sort of cleverness which catches every tone except the humorous.  Happily she never attempted to joke, and this perhaps was the most decisive mark of her cleverness.' 

‘For we all of us, grave or light, get our thoughts entangled in metaphors, and act fatally on the strength of them’ says Eliot, as she entertains us with wonderful ‘drawing room’ comedy, and steers her characters towards their inevitable destinies. Lydgate has a conviction that ‘the medical profession as it might be was the finest in the world; presenting the most perfect interchange between science and art; offering the most direct alliance between intellectual conquest and the social good’. He has ambitions to change the world of provincial medical practice. 

Eliot researched her material properly, and the great physicians of the age appear in ‘Middlemarch’. These include Bichat, the French pioneer of anatomical pathology and passionate advocate of post-mortem; Walkey, founder of The Lancet in 1823 who insisted a coroner should have medical training; Pierre Louis, an expert on typhoid fever, famed for introducing statistical analysis and becoming the first scientific epidemiologist; and Laennac; who first described the use of the stethoscope, initially a wooden funnel, in his ‘Traitè de 1'auscultation mèdecite’. 

 Meanwhile, the Middlemarch folk have other ideas, like Mrs Farebrother on sticking with one set of rules: ‘Excuse me there. If you go upon arguments, they are never wanting, when a man has no constancy of mind. My  father never changed, and he preached plain moral sermons without argument, and was a good man- few better. When you get me a good man made out of arguments, I will get you a good dinner with reading you the cookery book. That’s my opinion, and I think anybody’s stomach will bear me out.’

“Does this Mr Lydgate mean to say there is no use in taking medicine?” said Mrs Mawmsey, who was slightly given to drawling.  'I should like him to tell me how I could bear up at Fair time, if I didn't take a strengthening medicine for a month beforehand...But what keeps me up best is the pink mixture, not the brown…” 

The townsfolk are suspicious of Lydgate’s post-mortem enthusiasm imported from the medical school in France he attended, and the case of Burke and Hare is raised. Burke was hanged in 1829 for procuring anatomical specimens for dissection while his victims were still alive: he was a real life Jack the Ripper. Lydgate persists in his plan to open a better fever hospital, infectious disease being a significant killer in England up until about World War Two (when antibiotics came along), but must now cope with the religious and civil divisions in the community. One source of conflict is another doctor: 

“But what I contend against is the way that medical men are fouling their own nest, and setting up a cry about the country as if a general practitioner who dispenses drugs couldn't be a gentleman. I throw back the imputation with scorn.  I say the most ungentlemanly trick a man can be guilty of is to come among the members of his own profession with innovations which are a libel on their time-honoured procedure.  That is my opinion, and I am ready to maintain it against anyone who contradicts me”.  Mr Wrench's voice had become exceedingly sharp.’ 

Mr Powderell's wife has the erysipelas so he uses Lydgate's methods, in combination with the usual Widgeon's purifying pills... 'and could not abstain from mentioning to Lvdgate that Mr Peacock on a similar occasion had administered a series of boluses which were not otherwise definable than by their remarkable effect in bringing Mrs Powderell round before Michaelmas from an illness which had begun in a remarkably hot August.' 

Eliot suggests ‘it was as useless to fight against the interpretations of ignorance as to whip the fog.’ But this is only one frustration for Lydgate, his marriage being another. He finds refuge in his work, a common reaction among medical men: 

'Lydgate certainly had good reason to reflect on the service his practice did him in counteracting his personal cares.  He had no longer free energy enough for spontaneous research and speculative thinking, but by the bedside of patients the direct external calls on his judgement and sympathies brought the added impulse needed to draw him out of himself. It was not simply that beneficent harness of routine that enables silly men to live respectably and unhappy men to live calmly- it was a perpetual claim on the immediate fresh application of thought, and on the consideration of another's need and trial.  Many of us looking back through life would say that the kindest man we have ever known has been a medical man, or perhaps that surgeon whose fine tact, directed by deeply-informed perception, has come to us in our need with a more sublime beneficence than that of miracle-workers.  Some of that twice-blessed mercy was always with Lydgate in his work at the Hospital or in private houses, serving better than any opiate to quiet and sustain him under anxieties and his sense of mental degeneracy.' 

Lydgate’s story is only one thread of this magnificent novel, which I have presented last in this series on the literature of medicine in the hope you might feel inspired to take it on during the holidays. Approach Eliot with patience and she will reward you greatly.

References and Further Reading 

Middlemarch has been reprinted many times. I used the Penguin Classics edition. 

Other major works of medical literature you might be interested to tackle are Alexander Solzhenitsyn’s ‘Cancer Ward’ and Thomas Mann’s ‘The Magic Mountain’ (which confirmed him as a Nobel laureate).