“MIDDLEMARCH” and the PHYSICIAN (“MIDDLEMARCH” and SIR WILLIAM OSLER) by H

“MIDDLEMARCH” AND THE PHYSICIAN (“MIDDLEMARCH” AND SIR WILLIAM OSLER) By H. A. DEROW, M.D. BOSTON, MASS. “ A SK the opinion of a dozen medical men There are few things better worth the pains / upon the novel in which the doctor in a provincial town like this. A fine fever L \\ is best described, and the majority hospital in addition to the old infirmary might / \\ will say ‘Middlemarch.’” be the nucleus of a medical school here, when we Sir William Osler. once get our medical reforms; and what would George Eliot’s chief object in “Middle do more for medical education than the spread of such schools over the country? march” was to show that “There is no creature whose inward feeling is so strong The extent of the scientific knowledge of that it is not greatly determined by what Lydgate’s colleagues in Middlemarch (the lies outside it, and in obedience to this law, time of the novel is about 1830), as expressed character grows or decays.” Lydgate, the by him, is indicated by the following: physician, is the central figure of special As to the higher questions which determine interest whose career is emblazoned with the starting point of a diagnosis—as to the a great moral for the medical profession. philosophy of medical evidence—any glimmer Settling in Middlemarch, a provincial ing of these can only come from a scientific town of England, Lydgate decided to be a culture of which country practitioners have good Middlemarch doctor and by that usually no more notion than the man in the moon. very means keep himself in the track of Copious bleeding and blistering was the far reaching investigations. In his student order of the day and professional practice days, his scientific interest had taken consisted chiefly in giving a great many him to London, Edinburgh and Paris. drugs, the public inferring that it might be He longed to demonstrate the more inti better off with more drugs, if they could mate relations of living structure by dili only be gotten cheaply, so that a pitiful gent application, not only of the scalpel, deluging of patients with physic resulted. but of the microscope. Such was Lydgate’s Lydgate soon incurred the animosity of plan of his future: to do good small work for his brother-physicians by diagnosing with Middlemarch and great work for the world. the utmost facility conditions that were He determined to keep away from the enigmas to his colleagues. His new methods range of London intrigues, jealousies and of treating fever, according to Louis, of social truckling, and win celebrity, however Paris, met with smarting criticism, and his slowly, as Jenner had done, by the inde attempts to discredit the sale of drugs were pendent value of his work. Lydgate was called ungentlemanly. His failure to dis ambitious above all to contribute towards pense drugs was considered offensive both enlarging the scientific rational basis of to the physicians whose exclusive distinc his profession. tion seemed infringed upon, and to the sur I should never have been in any profession geon-apothecaries with whom he ranged that did not call forth the highest intellectual himself. Only a short time before, they strain, and yet keep me in good warm contact might have counted on having the law on with my neighbors. their side against a physician who dared to His zeal toward the establishment of ask for payment except as a charge on drugs I the medical school in the town may be Despite the severe judgment accorded him inferred from: by his fellow-physicians, he tried the expectant theory of treatment in a case of found himself, due to his wife’s extrava lobar pneumonia in a robust man, permit gances, pressed upon him constantly, and ting Nature to do its share in restoring the cast the blight of irony over all his higher patient’s health, instead of filling him with efforts. shotgun prescriptions. The patient got well. One may easily discern from several The care which he exercised in weighing dialogues between Lydgate and his wife the carefully all items that enter into considera state of affairs that existed between them: tion in arriving at a prognosis in a case, and “Why, what can a man do when he takes to a display of that rare virtue in physicians, adoring one of you mermaids? He only neglects i.e. humility, may be gleaned from his his work and runs up bills.” account of a patient who suffered from “I am sure you do not neglect your work. arteriosclerotic heart disease and who had You are always at the Hospital, or seeing poor just sustained a stroke of apoplexy: patients, or thinking about some doctor’s quarrel; and then at home you always want to The first thing that I must impress upon you pore over your microscope and phials. Confess is that my conclusions are doubly uncertain— you like these things better than you like me.” uncertain not only because of my fallibility, but “Haven’t you ambition enough to wish that because diseases of the heart are eminently your husband should be something better than difficult to found prediction on. In any case, a Middlemarch doctor?” one can hardly increase appreciably the tremen “Still, I do not think it is a nice profession.” dous uncertainty of life. “It is the grandest profession in the world. Lydgate felt sure that if he ever married, To say that you love me without loving the his wife would have that feminine radiance, medical man in me, is the same sort of thing as that distinctive womanhood which must to say that you like eating a peach but don’t like be classed with flowers and music, that sort its flavour.” of beauty which by its very nature is The habits of Lydgate’s profession, his virtuous, being moulded only for pure and home preoccupation with scientific subjects, delicate joys. which seemed to her like a morbid vampire’s I feel sure that marriage must be the best taste, his peculiar views of things which thing for a man who wants to work steadily. had never entered into the dialogue of He has everything at home then—no teasing courtship, all these continually alienating with personal speculations—he can get calmness influences made his presence dull to her. and freedom. To Lydgate it seemed that he had been His marriage with a selfish and socially spending month after month in sacrificing ambitious young provincial marked the more than half of his best intent and best beginning of the sacrifices he was to make power in his tenderness for his wife, bearing subsequently at the expense of his ambi her little claims and interruptions without tions and ideals. His wife was wholly at impatience, and above all, bearing without variance with his ideals, and lacked that betrayal of bitterness to look through less sympathy of purpose towards her husband’s and less of interfering illusion at the blank, activities that is so essential in a physi unreflecting surface her mind presented to cian’s wife. She harassed his plans and his ardor for the more impersonal ends of thoughts with an obstinacy that produced his profession and scientific study, an ardor its own bitter effect later in his life. Debts, which he fancied that the ideal wife must far in excess of her husband’s income, were somehow worship as sublime, though not incurred by her, handicapping him all the in the least knowing why. Lydgate was more. She tried to interfere with his medical aware that the concessions to his wife were practice, and dictate the course of action often little more than the lapse of slackening for him to follow in treating his patients. resolution, the creeping paralysis apt to The financial indebtedness in which he soon seize an enthusiasm which is out of adjust ment to a constant portion of our lives. treatise on Gout. His skill was relied upon Under the first galling pressure of fore by many paying patients. His acquaintances seen financial difficulties, and the percep thought him enviable in the possession of so tion that his marriage, if it were not to be a charming a wife. yoked loneliness, must be a state of effort Lydgate always regarded himself a fail to go on loving without too much care about ure: he had not done what he once meant to being loved, he had once or twice tried a do. His ambitions to carry on the work of dose of opium. It is indeed an easy matter the great Bichat in the quest for the for a physician confronted with such trou “primitive tissue” were never realized. bling situations to yield to that most per It was regrettable that Lydgate, gifted with nicious and yet soothing mental anodyne, great powers and fired with high ambitions, opium, thereby shirking the reality of his should be brought down by the domestic pressing and immediate responsibilities. But reality of his wife to a very ordinary achieve Lydgate had no constitutional craving after ment. The cares which his marriage to a such transient escapes from the hauntings selfish and socially ambitious girl brought of misery. upon him were serious handicaps to the How different a course De Quincey pur realizations of his ideals. He called his sued when beset with difficulties of a wife a basil plant once; and when she somewhat dissimilar nature! De Quincey asked for an explanation, said that basil confessed that: was a plant that flourished wonderfully on I cannot face misery, whether my own or not a murdered man’s brains! with an eye of sufficient firmness.

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