Medical Reform
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.
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 33 – A stand microscope created by Joseph Gutteridge, a weaver from Coventry (1860), the Herbert Art Gallery & Museum.
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.”
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.
Exhibit 36 – Bablake Hospital looking down the hill, Coventry, c. 1819, by William Henry Brooke, (the Herbert Art Gallery & Museum) and c. 2022 by Aaron Law.
Exhibit 37 – The Inner Court of Greyfriars Hospital, Coventry, c. 1819, by William Henry Brooke, (the Herbert Art Gallery & Museum) and c. 2022 by Aaron Law.
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).
Exhibit 38 – A fictional list of the directors of the Middlemarch Infirmary, with their occupations and their votes for Chaplain noted. From George Eliot’s Quarry for Middlemarch, MS Lowell 13. Houghton Library, Harvard University.
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’.
Exhibit 39 – A section of the Board of Health Map for Coventry, depicting Much Park Street, Little Park Street, Cow Lane, St John’s Street and Greyfriars Lane (1851), Coventry Archives, Culture Coventry Trust.
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.
Exhibit 42 – A man absurdly well-prepared for the cholera epidemic of 1832; representing the overabundance dubious advice on how to combat cholera. (1832), Wellcome Collection.
Exhibit 43 – A woman extravagantly equipped to deal with the cholera epidemic of 1832; representing the abundance of dubious advice on how to combat cholera. (c. 1832), Wellcome Collection.
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.
Exhibit 45 – ‘Present mode of applying a Pitch Plaister!!’ by Dickey Fubs, (1828), Coloured Etching, Wellcome Collection.
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.
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’.
Exhibit 44 – ‘The oracle of Harley Street, a long way through a short life’ by A. Sharpshooter, Coloured Etching, (1830), Wellcome Collection.
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.
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.’
Exhibit 51 – Heart: six figures, with blood-vessels and nerves indicated in red and blue. Coloured line engraving by W.H. Lizar, (c. 1826), Wellcome Collection.
[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.
