This online exhibition, curated by Dr Rosalind White (Royal Holloway, University of London) opens out the history of nineteenth-century Coventry through the lens of George Eliot’s Middlemarch: A Study of Provincial Life (1871).
How to cite this research: White, Rosalind. (2022) ‘Part Four: Medical Reform and the Distrust of Doctors’, Finding Middlemarch [Online Exhibition]. Royal Holloway, University of London. In collaboration with Nuneaton Museum & Art Gallery, Nuneaton Library, Coventry Archives and the Herbert Art Gallery & Museum and funded by the Arts Humanities Research Council. Retrieved from Exploring Eliot [https://exploringeliot.org/discover-george-eliot/finding-middlemarch/medical-reform/]
‘For everybody’s family doctor was remarkably clever […] the evidence of his cleverness was of the higher intuitive order, lying in his lady-patients’ immovable conviction, and was unassailable by any objection except that their intuitions were opposed by others equally strong.’
George Eliot, MIDDLEMARCH, Chapter 15.
Bedside medicine — as both a science and as a practice — changed profoundly from the 1830s (when Middlemarch is set) to the 1870s (when it was published). Tertius Lydgate’s more progressive approach stands in stark opposition to the ‘heroic medicine’ practiced by his provincial peers.
The simmering animosity between Lydgate and the other medical men of Middlemarch exemplifies wider tensions that existed in the 1820s and 30s among those who championed ‘heroic medicine’ and those who subscribed to a more empirical, observational approach grounded in anatomical knowledge.
‘Heroic medicine’, as it was known, hinged on the belief that bloodletting, blistering, purging, and sweating could clear impurities or shock the body back into health by restoring a supposed holistic balance of fluids. As Middlemarch‘s narrator notes in chapter 15, the age of heroic medicine ‘had not yet departed’. A domestic medicine chest in the 1830s, (exhibit 32) with its many emetics and laxatives was often geared towards inducing vomiting, sweating or diarrhoea.
A physician’s professional reputation, particularly in the provinces, was indivisible from their interpersonal relationships and social standing.
Practitioners would carefully tailor a prescribed treatment to satisfy their often finicky patients. Those who feared ‘strengthening medicine’ might fatally fortify the disease they had contracted could induce vomiting or leech their body of ‘excess’ blood. While those who considered depletion ‘medical perdition’ took strength from swallowing ‘large cubic measures’ of the latest drug.
Success was often contingent on emotional appeasement rather than physical improvement of one’s clientele. One of Lydgate’s saving graces, the narrator wryly notes, is that he ‘had the medical accomplishment of looking perfectly grave whatever nonsense was talked to him’.
What counted, Eliot infers, was the perceived responsiveness of one’s physician. Middlemarchers, are quick to disregard Mr Toller’s ‘lazy manners’ for ‘when he came, he did something’. In contrast to the theatrics of Toller’s treatment or the ‘black and drastic’ contents prescribed by Wrench, the impassiveness of Lydgate’s observational approach is regarded as positively insulting by many in Middlemarch. As Mrs Mawnsey (a great disciple of Dr Minchin’s mysterious ‘pink mixture’) exclaims ‘Does he suppose that people will pay him only to come and sit with them and go away again?’
Exhibit 32 – Domestic medicine chest and contents, (c. 1836), Powerhouse Museum Collection. Gift of D H Dougan and D F H D Dougan. Photographer Marinco Kojdanovski.
This was a time when few physicians had access to scientific instruments that could aid their examinations. Lydgate’s use of a stethoscope in chapter thirty (to diagnose Mr Casaubon with ‘fatty degeneration of the heart’), Eliot pointedly notes had not yet ‘become a matter of course’.
But by the time Middlemarch was penned, in the late 1860s, doctors had an ever-expanding variety of instruments at their disposal. Use of the stethoscope had become commonplace, ears were examined with an auroscope, eyes by an ophthalmoscope and the throat with a laryngoscope. Doctors with access to a laboratory could even examine their patient’s blood or urine under the microscope.
TERTIUS LYDGATE I The Unorthodox Outsider
Lydgate is an optimistic young surgeon new to Middlemarch society. Educated in Paris and Edinburgh, he sees himself as a representative of progressive medicine and is thus critical of the then customary tripartite division of medicine into physician, surgeon, and apothecarist. His passion for medical reform causes considerable animosity between himself and his medical peers in Middlemarch. This enmity is exacerbated by Lydgate’s moral stance on those who profit from the sale of drugs — a position that is perceived as injurious to the profession as a whole.
DR SPRAGUE | the Established Authority
Dr Sprague is the ‘senior physician’ in town. According to our narrator, his standing had been fixed thirty years ago by a treatise on meningitis. His opinion holds the most ‘weight’ among Middlemarch’s populace. He is scathing of Lydgate’s ‘certain showiness as to foreign ideas’ and perceives him to have ‘a disposition to unsettle what had been settled and forgotten by his elders’.
DR MINCHIN is a trusted physician, second only to Dr Sprague. His resemblance to ‘a mild clergyman’ lends credence to his reputation for being able to exorcise hidden ailments while they are still ‘lurking’ beneath the surface. Along with the other medical men of Middlemarch, he believes Lydgate to be ‘insolent, pretentious, and given to reckless innovation for the sake of noise and show’. When Minchin misdiagnoses a young woman with cancer he is ‘inwardly annoyed’ that Dr Lydgate contradicts his diagnosis and treats her stomach complaint successfully with a ‘blister and some steel mixture’. He is vexed further when the case continues to be described by Middlemarchers as one of tumour, and the young woman’s ‘speedy restoration’ is taken as evidence of Lydgate’s ‘marvellous skill.’
MR WRENCH is ‘medical attendant to the Vincy family’ and a proponent of ‘the strengthening treatment’. He is quick to overlook Fred’s illness (a case of typhoid fever) and sends along his ‘usual white parcels’ whose ‘black and drastic contents’ fail to improve Fred’s condition. His ‘irascible temper’ is inflamed when he learns that Lydgate has treated Fred in his absence. The Vincy family rebuke him for his misdiagnosis, and ultimately he is so insulted by the idea of being instructed by ‘a younger man, like Lydgate’ he declines to further attend on the case. He is particularly scornful of medical men, like Lydgate, who foul ‘their own nest’ and question the gentlemanliness of a ‘general practitioner who dispenses drugs’.
MR TOLLER is another ‘long established practitioner’ in Middlemarch and a ‘well-bred, quietly facetious man’ belonging to an old Middlemarch family. He is an advocate of the ‘lowering system’, and given to ‘the heroic treatment, bleeding and blistering and starving his patients’. Together with Mr Wrench, he believes that Lydgate’s decision not to dispense drugs is ‘intended to cast imputations’ on the longstanding practices of physicians such as himself.
MR GAMBIT is described by Mr Mawkmsey as ‘a practitioner just a little lower in status than Wrench or Toller, and especially esteemed as an accoucheur’, (midwife). He is perplexed by Lydgate’s unwillingness to prescribe drugs and thinks of him as ‘one of those hypocrites who try to discredit others by advertising their own honesty’. He is the subject of professional contempt by his peers, having not had ‘great resources of education’. Despite the fact his medical practice is ‘much pervaded by the smells of retail trading’, the narrator tells us he makes ‘none the worse accoucheur for calling the breathing apparatus “longs.”’
Though the microscope had been around for centuries the marvels it revealed were only just becoming widely available. The microscope makes frequent appearances in Middlemarch, both literal and metaphorical — through which Eliot’s narrator concentrates ‘all the light [they] can command’ on ‘this particular web’ of relations.
From the 1830s, cell theory became the focus of biological research. In 1838 microscopic observations of plant matter by German botanist Matthias Schleiden and similar observations of animal tissue by German physiologist Theodor Schwann laid the foundations for the idea of the cell as a fundamental unit of life shared by all living organisms.
Ultimately, this led to Arthur Hill Hassall, a British physician, pioneering use of the microscope as a tool to improve public health in his two-volume study ‘The Microscopic Anatomy of the Human Body in Health and Disease’, published in 1846.
Contemporary readers with a knowledge of cell theory would have been aware of the inherent flaws in Lydgate’s impassioned quest to find what he calls ‘primitive tissue’. As the narrator puts it, his question ‘what was the primitive tissue?’ is put ‘not quite in the way required by the awaiting answer’.
In this context, Lydgate’s thoughtless decision to give away his copy of Robert Brown‘s ‘Microscopical Observations’ — a botanical work on the study of pollen in plants that could have led him down the path of Schleiden and Schwann — is framed as tragically short-sighted.
Exhibit 34 – A woman drops her porcelain tea-cup in horror upon discovering the monstrous contents of a magnified drop of the Thames; revealing the impurity of London drinking water. Coloured etching by W. Heath, (1828), Wellcome Collection.
Exhibit 35 – The imagined monstrous contents of a magnified drop of Thames water; (1828), by W. Heath, via Wellcome Collection, vs the marine microfauna to really be found in a magnified 60mm petri dish (2006) by photographer David Liitschwager, via Wikimedia Commons. “‘The planktonic soup includes bug-like copepods; long, glassy arrowworms; coiled filaments of cyanobacteria; rectangular algae called diatoms; fish eggs; and a big-eyed larval crab the size of a rice grain.”
‘Even with a microscope directed on a water-drop we find ourselves making interpretations which turn out to be rather coarse; for whereas under a weak lens you may seem to see a creature exhibiting an active voracity into which other smaller creatures actively play […] a stronger lens reveals […] a play of minute causes.’
George Eliot, MIDDLEMARCH, Chapter 6.
Eliot was undoubtedly influenced by her partnership with George Henry Lewes, who was himself an impassioned practitioner of microscopy. As Lewes noted in ‘Only a Pond’ (1859), an article he wrote for Blackwood’s Edinburgh Magazine, many pass by their local pond without thought; ‘for the majority disregard the familiar objects of daily life and see neither wonder nor beauty except in what is unusual or costly.’ In the opening to chapter six, Eliot presents a parallel argument against those who would overlook provincial life as a subject unworthy of scrutiny.
Like Rev. Farebrother who visits Dr Lydgate to examine his ‘pond animacules’ under a superior lens, Middlemarch’s narrator conceives of themself as an amateur microscopist, observing a ‘play of minute causes’. Using the metaphor of a microscope directed on a water droplet, the narrator zooms in on Mrs Cadwallader’s attempts to make a match between Celia Brooke and Sir James Chettam. In doing so, they comically transform her into a voracious specimen of pond life. For though at a distance her gossiping appears innocuous, closer examination reveals the ‘thought and speech vortices’ she employs to exert her interests.
The Coventry and Warwickshire Hospital was founded in 1838 when George Eliot was still a teenager. There are many parallels between its founding and the medical politics involved in the origins of Middlemarch’s new fever hospital.
Prior to the Age of Enlightenment, a ‘hospital’ served as a holistic space that provided hospitality to those in need, rather than as a place expressly for healing illness and injury. Many of these institutions sprang up around Coventry to serve as alms-houses for the poor or deprived — from Bablake Hospital, established by Thomas Bond in 1506 to Greyfriars or Ford’s Hospital founded in 1529. However, in the early nineteenth century a distinction gradually developed between medicine and poor relief.
Coventry’s growing population coupled with poor sewerage, squalid living conditions, and severe overcrowding placed increasing pressure on these charitable establishments. The city’s expanding burial grounds were perilously close to its centre and grimy, poorly managed waterways caused frequent flooding. Sickness and injury were particularly prevalent among the manufacturing population, who occupied cramped, damp housing and spent the majority of their time at the loom.
Can you take a picture of modern Coventry that corresponds with a painting from the past? You can visit our Google Map to find an approximate location of the artist’s vantage point and post your photo on Twitter under the hashtag #FindingMiddlemarch. Photographs posted may feature in later parts of the exhibition.
In answer to the public outcry surrounding unceasing disease outbreaks and a mounting death toll, the Coventry and Warwickshire Hospital was founded in 1838. Initially, the hospital was a converted private house and had only twelve beds available.
Three doctors were appointed – Bourne, Mellor (who had attended Eliot’s father in 1836) and Arrowsmith. A committee was formed to establish the hospital. Like Eliot’s fictional list of the directors of the Middlemarch infirmary, (exhibit 38) the signatories are comprised of a wide variety of individuals from varying occupations and walks of life.
Among them are a number of individuals with a connection to George Eliot. John Howells, Vicar of Holy Trinity held the lease on the Evanses Foleshill house. Rev. C. H. Bracebridge was, according to Eliot, a ‘muddle-headed magistrate’ she had known in her youth who subsequently perpetuated the false rumour that a Mr Joseph Liggins was the author of Scenes of Clerical Life (Letters 3: 162) . Most notable is the Rev. J. Sibree, (father of Eliot’s friend Mary Sibree), and Joseph Cash (a textile merchant and father of Eliot’s friends John and Joseph Cash).
Like Middlemarch’s new fever hospital (financed by Bulstrode and kept afloat with generous donations from Dorothea) the Coventry and Warwickshire Hospital was privately funded. Prior to its founding, two dispensaries existed – the older charitably run General Dispensary, established on the principle of gratuitous assistance to the poor, and the self-financing Provident Dispensary, funded primarily by paying members. The former merged with the hospital, but the latter refused to join on the grounds that gratuitous relief to out-patients opposed the principles of a self-supporting subscription-run dispensary. In Eliot’s novel, similar tensions exist between the old infirmary and the New Hospital. Local residents and the whole medical profession we are told ‘have set themselves tooth and nail against the Hospital, and not only refuse to co-operate … but try to blacken the whole affair and hinder subscriptions’.
“There are few things better worth the pains in a provincial town like this,” said Lydgate. “A fine fever hospital in addition to the old infirmary might be the nucleus of a medical school here […] and what would do more for medical education than the spread of such schools over the country?”
George Eliot, MIDDLEMARCH, Chapter 13.
The expected arrival of cholera — a bacterial infection of the small intestine transmitted through contaminated water or food — is an ever-present threat in Middlemarch. The acute diarrhoea that characterised the disease brought about severe dehydration, collapse, and in many cases death.
Hastened by the territorial expansion of the British Empire and the arrival of increasingly faster modes of transportation, cholera spread from Bengal, India to British shores in 1831.
As Eliot notes in her research Quarry, despite local quarantines, by 1832 there had been 1530 cases and 802 deaths in London alone. Widespread public fear ensued along with four epidemics in Britain, the last of which ended only a few years before Eliot began Middlemarch.
Eliot’s entire life — like that of many of her readers — would have been punctuated by these outbreaks.
During the first outbreak in 1832, when Eliot was 13, their local curate Mr Gwyther (and the supposed model for Amos Barton in Scenes of Clerical Life) banned parish wakes at Chilver’s Coton ‘on the dubious ground that people coming from places around might bring the cholera with them’ (Haight 212). In a letter to the Brays, written during the second wave, Eliot expressed relief upon hearing her Coventry friends were ‘well and cheerful’; for when she thinks ‘of all that might happen in a fortnight … in these days of cholera and crises’ she ‘cannot help being anxious’ (Letters 1: 316).
In July 1849, a matter of months after Eliot left Coventry after the death of her father, the city established a local Board of Health to tackle the underlying sanitation issues responsible for the virulence of cholera. Shortly before Britain’s third pandemic, in 1851, the board produced a map in accordance with the provisions of the 1848 Public Health Act.
The map (comprising 26 sheets) was prepared by the Ordnance Survey Department on a large scale to serve as a tool for sanitary planning. Details such as the relative location of homes, schools, workplaces and washhouses in comparison with both the waterways and sites of questionable hygiene (like slaughterhouses, privies, dung heaps, stables, pig sties and factories) collectively give us a clearer picture of the congested nature of Victorian Coventry. The map is available in its entirety at Coventry Archives and as an overlay alongside a modern map of the city at CoventryAtlas.Org.
“Oxygen! nobody knows what that may be – is it any wonder the cholera has got to Dantzic? And yet there are people who say quarantine is no good!”
George Eliot, MIDDLEMARCH, Chapter 45.
In Middlemarch cholera is first mentioned in passing when the narrator imagines ‘what a shudder’ statistical data like ‘the cubic feet of oxygen yearly swallowed by a full-grown man’ would elicit in some Middlemarch circles: “Oxygen! nobody knows what that may be – is it any wonder the cholera has got to Dantzic? And yet there are people who say quarantine is no good!” Cholera’s progression towards Middlemarch is presented as a looming threat, that the townsfolk have little concept of. As Mary Wilson Carpenter has noted, though the spread of cholera ‘from the dark territory of colonial India obsessed the British public’ — when a once “tropical” illness emerged as a cosmopolitan disease — in Middlemarch it is given little precedence and appears as only ‘one of many topics of discussion’ (Carpenter ‘Medical Cosmopolitanism’ 511). In a provincial town, Eliot infers, the local populace of the 1830s cannot help but be lulled into a false sense of security by the unchanging tedium of provincial life. As the narrator sardonically reports, ‘railways were as exciting a topic as the Reform Bill or the imminent horrors of Cholera’.
In this context, Lydgate’s determination to put ‘good practical precautions for the town’ in place would have been read as admirably prescient by turn-of-the-century readers, who were all too aware of the consequences of what was to come for ill-prepared provincial towns. In her Quarry for Middlemarch Eliot documents the press and politics that accompanied the cholera pandemic of 1826-37. She focuses, with some detail, on the failure of both central and local governments to anticipate the disease. At the end of 1831, cholera spread from Sunderland to Newcastle to Edinburgh. In spite of this, she records, legislature remained ‘silent’ until the disease hit London; when ‘all at once’ bills were ‘hurried through parliament’ vesting the Privy Council with ample and expedient powers to ‘direct sanitary measures’ and ‘cover the necessary expenses’.
Armed with authorial knowledge of the death-toll towns like Middlemarch would face, Eliot is careful to point out that Lydgate has the foresight to include in the new fever hospital a specialised ward ‘in case of the cholera’. Though the other doctors are quick to deride this decision and malign the new-fangled ‘theories of treatment’ he is preparing, he receives support from Rev. Farebrother.
Standing in to some degree for Eliot, Farebrother responds with a gentle reminder that, when it comes to cholera, ‘none of [them] are very sure what [they] ought to do’.
Exhibit 40 – On Country Hospitals. From George Eliot’s Quarry for Middlemarch, MS Lowell 13. Houghton Library, Harvard University.
Text reads: ‘‘Meeting to advocate New College of Medicine. Certificates from County Hospitals not accepted by Coll. of Surgeons: yet says Wakley the county hospitals are better than the London: the men as eminent, the hospitals not so crowded with pupils.’
Exhibit 41 – Notes on the “Treatment of Fever” as recommended by Dr. Watson. From George Eliot’s Quarry for Middlemarch, MS Lowell 13. Houghton Library, Harvard University.
Text reads: ‘Treatment of Fever (continued) Dr Watson’s recommendations are 1. against the old plan of “cutting short” the fever at the outset by emetics & cold affusions. But emetics perhaps too much neglected, being sometimes palliative early when there is gastric disturbance.‘
Lydgate’s interest in ‘the nature of fever or fevers’ is a recurrent theme, particularly that which ‘gave him that delightful labor of the imagination’ to contemplate the ‘subtler actions’ of human biology, then ‘inaccessible by any sort of lens’. He is keen to read Pierre Charles Louis’ ‘new book on fever’, and we learn that as a student he even attended a lecture by Louis in Paris on the ‘many anatomical demonstrations in order to ascertain the specific differences of typhus and typhoid’. Lydgate’s curiosity to ‘pierce the obscurity of those minute processes’, (unlike Casaubon’s esoteric intellectual labours), tangibly benefits those around him. Most notably when he dismisses the ‘medical etiquette’ of questioning another doctor’s diagnosis and saves the life of Fred Vincy by determining that he is ‘in the pink-skinned stage of typhoid fever’ and taking swift action.
The pandemonium that ensues when the Vincy’s learn that fever is in the house would have been as familiar to contemporary readers as it is to modern readers in the wake of repeated Covid lockdowns.
Thursday’s dinner party is regretfully cancelled and Mr Vincy coming home to the news emphatically determines that ‘brandy was the best thing against infection’ and sends for the butler.
While Mrs Vincy takes Wrench’s misdiagnosis as a purposeful choice to ‘neglect her children more than others’, and loudly proclaims within his earshot that her ‘boy might have been stretched a corpse!’ Mr Vincy takes refuge in metaphors of war and conflict.
Much like many of our modern governments’ militaristic take on Covid (from health care professionals on the “front-line” to directives for those at home to ‘stay alert, control the virus, save lives’), Vincy scolds Wrench for letting fever ‘get unawares into a house like this’. Mindful that this was not an occasion for ‘firing with blank cartridges’, and thus ‘keeping up a sharp fire on the enemy Infection’ (presumably via the aforementioned brandy), he takes great pleasure carrying out his mayoral duty to ‘rebuke offenders with an official air’.
An increased appetite for scientific knowledge led to a surge in the demand for fresh cadavers by medical institutions. In order to address the shortage, a new class of criminal emerged: the bodysnatcher. These ‘resurrection men’ raided burial sites to bundle fresh corpses into waiting carts to be transported and sold for scientific study.
Those who had recently lost loved ones were forced to take precautionary measures to guard against disinterment. Watchtowers to shelter those who stood on sentry duty and mortsafes or mortcages (coffins enclosed within a framework of iron bars) became increasingly common.
Medical men like Middlemarch’s Dr Lydgate, stirred by the ‘the growth of an intellectual passion’ and a desire to learn more about the innerworkings of the human body were viewed with distrust and suspicion, particularly in a provincial town where science itself was associated with breaking societal taboos.
Throughout Middlemarch Lydgate’s infatuation with anatomy is metaphorically described with a quasi-erotic intimacy indicative of this association. He recollects approaching an anatomy textbook for the first time with a ‘general sense of secrecy and obscenity in connection with his internal structure’ and describes his scientific awakening as both a sensual and spiritual ‘moment of vocation’.
In 1828, William Burke and William Hare murdered 16 individuals in Edinburgh by asphyxiation in order to sell their corpses for dissection to the surgeon Dr Robert Knox. This method came to be known as ‘burking’ and was thought to have involved pitch plasters.
This case is directly referenced in Middlemarch. ‘Mrs. Dollop, we are told, ‘became more and more convinced by her own asseveration, that Dr. Lydgate meant to let the people die in the Hospital, if not to poison them, for the sake of cutting them up […] there was a prevalent feeling in her audience that her opinion was a bulwark, and that if it were overthrown there would be no limits to the cutting-up of bodies, as had been well seen in Burke and Hare with their pitch-plaisters.’
Exhibit 45 depicts a man walking along a country path being attacked. The bodysnatcher, hiding behind a brick wall, asphyxiates him by thrusting a heart-shaped ‘pitch’ plaster in his face. Pitch — a resinous substance obtained from tar — could be used to treat rheumatic disorders, or as a depilatory to remove hair.
Middlemarch draws to a close in the months before the Anatomy Act of 1832 was passed — granting doctors and medical students the right to dissect donated cadavers in the service of education or research. The act however did little to diminish the illicit practice of body snatching, as the demand for corpses by medical schools far outstripped the lawful supply available.
Prior to the act, the only legal supply of bodies available for medical dissection came from criminals sentenced to death and dissection by the courts. This sentence was usually reserved for cases of murder. In August 1831, just a year before Middlemarch is set, such a case occurred in Coventry. A young woman, Mary Ann Higgins, was sentenced to death for poisoning her uncle with arsenic. After her hanging, her body was opened up by surgeons and publicly exhibited in the Old Bridewell where it was dissected before a large crowd. Her remains were exhibited again in 1919, and in the 1970s the Herbert Art Gallery & Museum received a mysterious bag containing her head. In the days following her dissection an observer wrote into the Coventry Herald to protest the indignity of the ‘humiliating spectacle’: remarking that the ‘revolting scene’, exposed her body ‘to the merely idle and curious […] of both sexes in one indiscriminate mass’ — a fact that ought to horrify all but those who possess ‘the coarsest and most brutal sentiments’. At least, they said, ‘let us wait till another Burke or Hare make their exit before the scene is repeated’.
The case of Mary Ann Higgins gives us some insight into why Lydgate’s interest in anatomy or, in Mrs Dollop’s words, his desire to ‘pry into your inside after you were gone’ proves especially ruinous to his reputation. Moreover, we can better understand why provincial opinion would have been further enflamed when Lydgate broached the subject of a postmortem with the relatives of ‘a respectable woman’ like Mrs Goby. That Mrs Goby’s family view Lydgate’s request ‘as a ‘flagrant insult to her memory’ is indicative of the fact that autopsy was then viewed as a form of posthumous punishment — a fate worse than death reserved for convicted murderers.
‘He did not mean to imitate those philanthropic models who make a profit out of poisonous pickles to support themselves […] he intended to begin in his own case some particular reforms which were quite certainly within his reach.’
Lydgate’s ruminations, MIDDLEMARCH, Chapter 15.
The distrust of doctors is a significant theme in Eliot’s Middlemarch. Prominent cases of medical malpractice coupled with an inherent suspicion of outsiders predispose the townspeople against Lydgate, a man who openly champions innovation and imported ideas.
In an article for Blackwood’s Magazine on ‘Physicians and Quacks’ (1862) Eliot’s partner G. H. Lewes wrote extensively about the fine line that then existed between the two. The key difference, he theorised lay in the fact that the ‘confidence of the physician is relative and tentative’, but ‘the confidence of the quack is absolute and final’; ‘the quack never doubts, never watches’.
Enlightened empiricism, for Lewes and for Lydgate is about uniting what one has learnt about the ‘structure and functions of the human body’ with what one experiences ‘at the bedside’. The wise physician, Lewes warns, ‘in the very sincerity of his wisdom, recognises the imperfection of his knowledge’ and is invariably at disadvantage; for the sick are far more likely to be taken in by the quack who ‘has not such doubts’ only an emphatic cure.
Embodying this approach, Lydgate regularly ‘sits quietly by his patient’ in observation; he is honest enough to offer Casaubon ‘the rather unsatisfactory prescription’ of lifestyle advice (‘you must submit to be mildly bored’) in lieu of profiteering from the sale of drugs or offering a ‘gratuitous prediction’ of his patient’s prognosis. What’s more, he is honest about the fact that Casaubon’s case is ‘difficult to pronounce upon’.
The other doctors of Middlemarch exercise no such caution and are all the more sought after for their propensity to ‘offer any hope when danger was extreme, and when the smallest hope was worth a guinea’.
‘Ready to combine against all innovators’, Middlemarch’s medical men are quick to denigrate Lydgate in an effort to sway their clientele, citing his ‘flighty foreign notions’, his ‘reckless innovation,’ and his apparent tendency to ‘unsettle what had been settled’ by his peers.
In Exhibit 44, John St. John Long (a dubious medical practitioner) is depicted as a funeral mourner surrounded by ducks (to indicate quackery) and placards which advertise several malpractice cases of his in which patients died.
Long claimed he could cure tuberculosis by using two mysterious substances. One was inhaled and the other was rubbed on the skin until patients developed a running sore, which purportedly allowed the disease to depart the body.
In 1830, Long was tried for the death of two of his patients at the Old Bailey. When he died of tuberculosis in 1834, he is said to have refused treatment by his own ‘secret formula’. Notes on Long’s trial are included in Eliot’s ‘Quarry’ for Middlemarch.
In an effort to paint Lydgate as a charlatan, Mr Toller references St. John Long’s infamy for ‘advertising cures in ways nobody knows anything about’. Like Long, he intimates Lydgate is the kind of fellow ‘who wants to make a noise by pretending to go deeper’ than his peers in order to play ‘with respectable constitutions for his own purposes’.
The quack medicine of the nineteenth century was characterised by a boon in universal cure-all pills ointments and tonics. Strengthening remedies of this kind are referenced throughout Middlemarch — from the mysterious ‘pink mixture’ favoured by Mrs Mawmsey to ‘Widgeon’s Purifying Pills’, ‘an esteemed Middlemarch medicine, thought to arrest every disease ‘by setting to work at once upon the blood.’
The 1830 British Parliamentary register includes thousands of ‘proprietary medicines’ with patented secret formulas. Some of these ‘strengthening’ or ‘purifying’ treatments included alcohol or opium, but many were essentially sugar pills or placebos with no active ingredient.
Doctors were largely dependent upon the money they made from prescriptions for their income and the questionable ethics such a system encouraged was a contentious, hotly debated topic. Lydgate’s penchant for openly questioning the gentlemanliness of a ‘general practitioner who dispenses drugs’ further alienates him from his provincial brethren, many of whom have faith in and rely upon these ‘strictly made items’.
Though Eliot undoubtedly agrees on principle with Lydgate’s beliefs (see, her Quarry notes on ‘Practitioners’ Remuneration’) her narrative decision to doom Lydgate to bankruptcy adds a layer of nuance and empathy to the debate. The aristocratic Lydgate that arrives in Middlemarch, she seems to suggest, can afford to have such beliefs. But the wearied Lydgate of Eliot’s epilogue (who has shifted his specialisation to gout, a disease with a ‘good deal of wealth on its side’) or Mr Wrench with his ‘lymphatic wife and seven children’ have neither the time nor the surplus income to make such a stand.
Exhibit 46 – A man in bed with vegetables sprouting from all parts of his body; as a result of taking an overdose of James Morison’s vegetable pills. By C.J. Grant, (1831), coloured lithograph, Wellcome Collection.
‘Professional practice chiefly consisted in giving a great many drugs, the public inferred that it might be better off with more drugs … and hence swallowed large cubic measures of physic prescribed by unscrupulous ignorance’.
George Eliot, MIDDLEMARCH, Chapter 15.
Exhibit 47 – An advert entitled ‘Morison and his system – versus – the doctors and their guinea trade’, published in ‘Hygeian Illustration’ to promote the business of pill-vendor James Morison, (c. 1848), Lithograph, Wellcome Collection.
George Eliot took copious notes on the rumours and fears that swirled in the public imagination surrounding those who practiced medicine. This included details on the difficulties of procuring bodies for dissection, cases of medical malpractice, and exposés of quackery.
Exhibit 48 – On the difficulty of obtaining bodies for dissection. From George Eliot’s Quarry for Middlemarch, MS Lowell 13. Houghton Library, Harvard University.
Text reads: ‘In 1823, bodies for dissection hardly to be obtained in London at any price “from the resurrection men.” Court of Examiners would not accept certificates of dissections made in Paris, where bodies were plentiful.’
Exhibit 49 – On theological prejudice against medical studies. From George Eliot’s Quarry for Middlemarch, MS Lowell 13. Houghton Library, Harvard University.
Text reads: ‘The Lancet writes about the theological prejudices against medical studies. A book on Adulteration & Slow Poisoning: or Disease & death in the Pot & the Bottle, just published. False alarms of the uninstructed on hearing that their porter is mixed with Quassia! their cheese coloured with anatto! their port wine roughened with tannin!’
Exhibit 50 – Quoted from Hone’s Table Book that the Empiric. From George Eliot’s Quarry for Middlemarch, MS Lowell 13. Houghton Library, Harvard University.
Text reads: ‘Dr Graham who appeared in London 1782 had a celestial bed, the charge for sleeping in which was £100. Several persons of high rank acceded to his terms, he pretending that it wrought miraculous effects.’
‘The page he opened on was under the head of Anatomy, and the first passage that drew his eyes was on the valves of the heart. He was not much acquainted with valves of any sort, but he knew that valvae were folding-doors, and through this crevice came a sudden light startling him with his first vivid notion of finely adjusted mechanism in the human frame. ‘
George Eliot, MIDDLEMARCH, Chapter 15.
[detail] Heart: six figures, with blood-vessels and nerves indicated in red and blue. Coloured line engraving by W.H. Lizar, (c. 1826), Wellcome Collection.
“Lydgate has lots of ideas, quite new, about ventilation and diet, that sort of thing,” resumed Mr. Brooke. […] “Hang it, do you think that is quite sound?—upsetting the old treatment, which has made Englishmen what they are?” said Mr. Standish.
George Eliot, MIDDLEMARCH, Chapter 10.
Fresh from a Parisian medical school and armed with an array of pioneering instruments Lydgate’s presence in Middlemarch generates considerable tension among his fellow practitioners. Throughout the novel, his progressive attitude is reflected in both the causes he champions and the treatments he prescribes. Eliot meticulously researched the politics of Reform-era medicine in order to position him as a forward-thinking surgeon, poised on the precipice of scientific greatness.
When Casaubon suffers from angina Lydgate’s use of the stethoscope helps him arrive at a quick diagnosis of coronary heart disease, (then termed ‘fatty degeneration of the heart’). Unlike his medical peers, who would have likely recommended blood depletion (a practice widely discredited by the 1870s) Lydgate feels it his duty, to be honest about Casaubon’s predicament despite the lack of closure such a prognosis offers: ‘death from this disease is often sudden [but]… at the same time, no such result can be predicted.’
Likewise, when John Raffles develops delirium tremens — brought on by alcohol poisoning Lydgate is against the ‘practice of allowing alcohol and persistently administering large doses of opium’, despite this then being common practice. Instead, he prescribes Raffles ‘extremely moderate’ quantities of opium. Notably, the theoretical origin of this new approach is an obscure American monograph, ‘Remarks on the History & Treatment of Delirium Tremens’, by John Ware, M.D, whose date (1831) only ‘just permits Lydgate to have been acquainted with it’ (Mason 431).
In the 1820s and 30s, the medical journal The Lancet emerged as a formidable force advocating for large-scale reform. Foundling editor Thomas Wakely, a surgeon and social reformer used his editorship to bolster a wide variety of campaigns — from exposing quackery to querying why coroners seldom had medical qualifications. Unlike his medical peers in Middlemarch, Lydgate is an open proponent of such reforms. In one heated exchange he is even accused of being ‘one of the ‘Lancet’s’ men’ — intent on taking ‘coronership out of the hands of the legal profession’.
Please cite this exhibition as follows: White, Rosalind. (2022) ‘Part Four: Medical Reform and the Distrust of Doctors’, Finding Middlemarch [Online Exhibition]. Royal Holloway, University of London. In collaboration with Nuneaton Museum & Art Gallery, Nuneaton Library, Coventry Archives and the Herbert Art Gallery & Museum and funded by the Arts Humanities Research Council. Retrieved from Exploring Eliot [https://exploringeliot.org/discover-george-eliot/finding-middlemarch/medical-reform/]