Middlemarch: Health & Medicine

Introduction

The Victorian attitude towards health was largely responsible for the increase in medical developments during the early 19th century. Victorians believed that studying the physiology of the body, its internal organs and how they were connected to the whole body, was an important concept in understanding the physiological man (Victorian Web). Eliot shows us a good example of this concern in her novel Middlemarch. Through the character of Dr. Tertius Lydgate, we are shown an embodiment of the evolution of Victorian ideas concerning health and medicine. Lydgate is a young and innovative doctor full of ideas and passionate about his life’s work. He is brought to Middlemarch to take up an open position within the newly built hospital, but his arrival causes contention. Lydgate’s theories and his adoption of new medical practices conflict with the older, more established physicians. An example of this appears in Chapter 26 of Book 1 when Lydgate’s diagnosis of Fred Vincy’s health contradicts the diagnosis made by the town’s country practitioner, Dr. Wrench. This conflict is a representation of the changes occurring during the 19th century. The medical field was growing more advanced than ever before, and, as a result, hospitals were sprouting up all throughout the countryside, an increasing number of doctors were receiving higher educations, and knowledge of medicine was experiencing great advances in response to diseases of the time,and over time, doctors like Lydgate became more common–all of which is reflected through the characters and plot lines in Middlemarch.

Medical Training

During the Victorian Age, the medical profession was becoming increasingly institutionalized. There were three different kinds of medical practitioners: apothecaries, surgeons and physicians. Apothecaries were doctors who could give medical advice and prescribe medicines but were limited in the hands-on department of physically treating patients. Surgeons were doctors who performed tasks such as pulling teeth and treating wounds and skin diseases. Many doctors of the time were often both apothecaries and surgeons as it was beneficial to their profession to be knowledgeable in both departments. These doctors did not have any medical degrees but learned their trades through internships and apprenticeships with established doctors. In contrast to apothecaries and surgeons, physicians were the only doctors to receive medical degrees. They were classically educated, studying at Oxford and Cambridge where they were required to read both Latin and Greek texts. However, their study did not include the hands-on experience that many apothecaries and surgeons internship included. Because of this, physicians were still considered gentlemen of their time and were among the upper echelon in the medical field (Mitchell 196).

In her novel, Eliot remarks upon each level of profession in the medical field as well as on some of the problems that the rigid class system could engender. She says,

For it must be remembered that this was a dark period; and in spite of venerable colleges which used great efforts to secure purity of knowledge by making it scarce, and to exclude error by a rigid exclusiveness in relation to fees and appointments, it happened that very ignorant young gentlemen were promoted in town, and many more got a legal right to practice over large areas in the country. Also, the high standard held up to the public mind by the College of which which gave its peculiar sanction to the expensive and highly rarefied medical instruction obtained by graduates of Oxford and Cambridge, did not hinder quackery from having an excellent time of it. (Eliot 145-146)

Eliot shows an example of a not-very-knowledgeable doctor when she introduces Dr. Wrench and his misdiagnosis of Fred Vincy. In Middlemarch, Dr.’s Minchin and Sprague were also country doctors while Mr. Lydgate is an example of a surgeon, though “rather more uncommon than any general practitioner in Middlemarch.” Eliot gives us an insight into his education when she writes, “when the boy Tertius asked to have a medical education, it seemed easiest to his guardians to grant his request by apprenticing him to a country practitioner than to make any objections on the score of family dignity,” which refers to the negative light that was increasingly being cast upon those doctors who did not attend university (Eliot 143). Following his apprenticeship, he travelled to London, Edinburgh, and Paris to study at the finest medical institutions, and while there he read all of the Latin and Greek texts available. After his education was completed, his every intention centered upon settling down in a provincial area and working to reform the medical professions as it was with the conviction that “the medical profession as it might be was the finest in the world” (Eliot 143, 145). Upon first arriving in Middlemarch, Lydgate began his work in the newly built hospital where he professed his passion for reform and talked of all the new practices among medicine.

Hospitals

Before the Victorian Age, hospitals were not regarded in a positive manner. They were places of ill repute where the poor, drunk, insane, and contagious were sent to live, often never to be released. At the turn of the century, a shift in their purpose led to modernizing hospitals. They became places where surgical procedures not suitable for the home could be performed by upstanding doctors. It was no longer a place for the ” mentally ill,” but somewhere patients could be expected to be admitted and released in a timely manner. This change in meaning was accompanied by an increase in the production of hospitals–by the 1800’s, there was at least one hospital in every county (Hughes 64). Hospitals were run by a board of doctors, these doctors were often the deciding factor on what kinds of practices would be performed in the hospital and who would perform them.

Eliot addresses this historical reality in her novel. In the town of Middlemarch, there was the newly built Middlemarch Fever Hospital. Its construction was financed through both public and private donations by town residents, as was common during this time, its leading donor being Mr. Bulstrode who was the biggest advocate of Dr. Lydgate. Although the hospital was staffed by local doctors, such as doctors, Minchin and Sprague, the medical supervision of the hospital was headed by the young Lydgate. Lydgate’s services, which were contracted by Mr. Bulstrode, were on a strictly voluntary basis and included no financial incentive. The board consisted mostly of older surgeons and physicians who were stuck in a traditional mindset. The biggest contention among the board was often between Lydgate who was a passionate reformist and traditionalists such as Drs. Sprague and Minchin.

Disease & Health

During the Victorian Age, tuberculosis was the number one cause of death–it is believed to be responsible for one-sixth of all deaths in the year 1838. It was commonly referred to as “consumption” and consisted of various symptoms including coughing, fatigue, weakness, night sweats and loss of appetite. Those afflicted with the disease could continue living up to a few months or a few years. TB most commonly affected women and those of the working class. Women of all classes were often kept inside and poor ventilation made their environments conducive to diseases such as TB. Those of the working class were also consistently victims of TB because they were under nourished and over worked. Apothecaries and physicians would prescribe opium, rest, a healthy diet and/or relocation to a warmer climate to those afflicted with the disease (Mitchell 193-194). Other diseases that were common during this time include typhoid, cholera, influenza and typhus. Outbreaks ranged from the 1830’s to the 1840’s, but as F. H. Garrison remarked, they did not scour the country, they were “more scattered and isolated” than previously recorded in history (Victorian Web).

In Middlemarch, Eliot first introduces the reader to disease when Fred Vincy is struck ill. The country practitioner, Dr. Wrench is first called and misdiagnosis him, assuming that he has a simple ailment. When Fred fails to improve, Lydgate is summoned and observes Fred’s symptoms and deduces that he has contracted typhoid fever. He then prescribes opium and alcohol alongside rest to cure him which were common remedies of the time. Other illnesses include Mr. Featherstone’s old age and Reverend Causabon’s heart problems. When Mr. Causabon collapses from illness, Dr. Lydgate is called in to see to his health and determines that he is being struck ill by a “disease of the heart.” He says, “I believe that you are suffering from what is called fatty degeneration of the heart, a disease which was first divined and explored by Laennec, the man who gave us the stethoscope, not so very many years ago” (Eliot 230). He further explains to Causabon that his diagnosis is not infallible and as a result of the unpredictability of the disease, he can not even pretend to gauge how much longer Causabon may live. Contrary to the knowledge that girls and women had higher death rates during the Victorian era and that a large number of deaths resulted from contagious diseases, in Middlemarch, men are consistently presented as the victims of illnesses, not women, and only one death in the story is attributed to an infectious disease.

Conclusion

Middlemarch by George Eliot endeavors to accurately portray life in the countryside during the Victorain age in England. Eliot’s attempts to capture the medical aspects of everyday life in a a provincial town through the character of Dr. Tertius Lydgate, and in her attempts, she shows the reader a glimpse of all manner of medical subjects, such as the inner workings of hospitals, the caste system in the medical profession, the education required to become a doctor, and the effects of disease and medicine on a population. Although her attempts were not completely successful, as can be seen in the Disease and Health section, she represents her findings in a factual manner. The documents that enable researchers today to determine the statistics of Victorian health were not accessible to Eliot while she was creating her novel, making it nearly impossible for her to be aware of the higher death rates for women and the toll infectious diseases had on the English population. With that in mind, Eliot successfully portrays the intricacies of Victorian medicine in a knowledgeable and thorough manner appropriate for her time.

Return to Middlemarch

References

Eliot, George. Middlemarch. London: Penguin Classics, 1994.
Hughes, Kristine. The Writer’s Guide to Everyday Life in Regency and Victorian England. Cincinnati, OH: Writer’s Digest Books, 1998.
Mitchell, Sally. Daily Life in Victorian England. Westport, CT: Greenwood Press, 1996.
Image: Victorian Web <http://www.victorianweb.org/painting/fildes/paintings/1.html>

Contributer

Diane Aiken