Science, Medicine & Women in Middlemarch

I started out the summer ambitiously, though I didn’t realize it at the time. Perceiving a declining ability to read fiction, I decided I needed to relearn how to not immediately try and find the thesis in any piece of writing I laid eyes on. What better tome to begin with than one I’d heard whispers around the department as being full of science and gender themes?!

I was in for a treat, but one for which I’d have to work pretty hard. George Eliot is no Jane Austen, and Middlemarch is no light read. In addition to science and gender, Eliot touches on provincial life, religion, ethics/morality, politics (and this one was probably the most prevalent), some technology, love and relationships, change, and so, so much more. While most of the notes I took and things I thought about orbited around a scientific and gendered perspective, I got a lot more from the book than that. And I’ll probably get something entirely different when I inevitably give it another read in a few years.

The book is a study of country life in England, and it is staged in a provincial town. It follows the lives of quite a few of the town’s residents, which is part of the reason the book is so damn long (my copy was 613 pages). I quickly located my favorite character in Tertius Lydgate, a physician from out of town with family in high places and some new, radical ideas about how to treat illness. He trained in Paris, which I found very interesting — at the time (1820s and 30s), the Parisian medical school and attached hospital were training physicians in the anatomo-pathological methodology. Inspired by rational, mathematical methods, these men (one of which is mentioned often in the book, Pierre C.A. Louis) found that patients treated with medicines of the time did not fare any better than those left more or less alone. As a result, these physicians and the students they taught thought it’d be more useful to let diseases take their course. Some of the sick died, after which time the medical men would dissect them and attempt to correlate their diseases/symptoms with internal “lesions,” or abnormalities. In this way, they hoped to discover the true causes of illness and propose new, more effective therapeutic options.

Lydgate’s medical philosophy, and how he feels about the state of medicine in England, reflect his French training. His impetus for entering the profession lay in a perception that the field was in dire need of reform. He found quackery to be indulged by the College of Physicians, “since professional practice chiefly consisted in giving a great many drugs…,” a phenomenon he understands as economically motivated; “…the public inferred that it might be better off with more drugs still, if they could only be got cheaply, and hence swallowed large cubic measures of physic prescribed by unscrupulous ignorance which had taken no degrees.” Lydgate understood medical reform as based around and shaped by statistics, and he would be a unit that, when it became obvious how much more logical and effective his medical philosophies were, would disseminate a more scientific, rational basis for his profession. He would be a medical messiah, converting the ignorant but eager-to-learn populace to a more enlightened medicine, and he would ambitiously begin his journey in a medical backwater — provinciality.

He planned, after concluding his Parisian studies, to “settle in some provincial town as a general practitioner, and resist the irrational severance between medical and surgical knowledge in the interest of his own scientific pursuits, as well as of the general advance: he would keep away from the range of London intrigues, jealousies, and social truckling, and win celebrity, however slowly, as Jenner had done, by the independent value of his work.” (108) Setting himself up in strong juxtaposition against flashy quacks and physicians who touted their powerful, cure-all remedies, Lydgate would let his slow, determined, mathematical, and scientific methods build his reputation for him. People would see the folly in whimsical, drug-based medicine when they realized how ineffectual it was; they would no longer be duped when presented with flashy adverts for cure-all tonics, and they wouldn’t trust a doctor simply because he prescribed the most violent of purgatives. Like his heroes — C. A. Louis, Jenner, Bichat — “Lydgate was ambitious above all to contribute towards enlarging the scientific, rational basis of his profession.” (109) And he was doing so largely with the common good in mind, dotted, of course, with dreams of professional glory.

In addition to presenting what medical reformers hoped for in the mid-1800s, Eliot does an excellent job of portraying the public backlash to such radical, novel ideas. On several occasions, enemies or skeptics of Dr. Lydgate accuse him of unnecessary or unholy dissection. A Mrs Dollop expressed a belief that “Dr. Lydgate meant to let the people die in the Hospital, if not to poison them, for the sake of cutting them up without saying by your leave or with your leave…” A good doctor, she asserts, need not cut open and look inside his patient to know what was wrong. (323) Lydgate’s hesitancy to prescribe medication made many of his patients feel as though he was not performing his duties as a doctor; they were accustomed to being prescribed drugs. How were they expected to get better with none? Were they getting their money’s worth? “…[O]nly a little while before, they [Lydgate’s skeptics] might have counted on having the law on their side against a man who without calling himself a London-made M.D. dared to ask for pay except as a charge on drugs.” (325) In a particularly telling passage in which Lydgate explains to Mr. Mawmsey, a grocer, why he does not prescribe much medicine, the public’s aversion to the idea is made more explicitly manifest;

“For years he [Mr. Mawmsey] had been paying bills with strictly-made items, so that for every half-crown and eighteenpence he was certain something measurable was delivered. He had done this with satisfaction, including it among his responsibilities as a husband and father, and regarding a longer bill than usual as a dignity worth mentioning. Moreover, in addition to the massive benefit of the drugs to ‘self and family,’ he had enjoyed the pleasure of forming an acute judgement as to their immediate effects, so as to give an intelligent statement for the guidance of Mr. Gambit — a practitioner just a little lower in status…” (325)

Not prescribing his patients medicine took the power of opinion and choice from them, and it made them feel stupid for wanting it. The result was defensiveness and aversion; Lydgate’s “logical,” mathematically-based arguments meant nothing to these people, who largely lived their lives by the personal experiences to which they were privy. Lydgate’s imported, academic arguments lay far outside their day-to-day understanding of their world and, more specifically, the workings of their own (and their lived one’s) bodies — they were unintelligible. That is not to say that this vernacular audience was incapable of understanding; far from it, had it been explained to them. But many found no fault with their current doctors’ methods and the agency they enjoyed in the doctor-patient relationship, and they resented intrusion into that trusted dynamic, particularly by someone espousing foreign, abstract theories.

Country doctors already practicing in Middlemarch expressed other, inter-professional anxieties, which often play out between old and new members of a changing order. They harbored prejudices against “a man who had not been to either of the English universities… but came with a libellous pretension to experience in Edinburgh and Paris…” (135), and they found his methods particularly offensive. “It was clear that Lydgate, by not dispensing drugs, intended to cast imputations on his equals.” By setting himself apart in training and practice, Lydgate was isolating and belittling his fellow physicians — he was a threat to their medical authority, and as such, he suffers many ill-founded and assumption-ridden denunciations (and a hell of a lot of negative gossip) throughout the story from his rivals. Thus, Eliot contends with the changing medical field and the popular backlash it elicited — a very useful piece of socio-medical commentary for the nineteenth century medical historian indeed!

Another theme that I found interesting in Middlemarch was that of the role of women. Two main females stuck out to me — Dorothea Brook and Rosamond Vincy. They were foils of one another, and one was clearly what Eliot would have perceived ideal femininity to consist of. Dorothea (amusingly called “Dodo” by her sister, Cecilia) was raised by her uncle and had very firm, religiously-informed ideas about what she wanted from life and how she would carry herself through it. She was always thinking about others before herself, finding ways she could make herself useful to them. Her mind was a sharp one, and she was determined to use it for the common good — or, more immediately, for the good of her husband. She marries an older clergyman, intoxicated with the idea that she would help him to complete his meticulously researched and brilliant magnum opus. After they marry, however, she discovers that his intellectual abilities are lackluster, and his insecurities about them prove a barrier to his allowing her to help him in any meaningful way. She spends a lot of time fully accepting her new position but nonetheless does her best to adapt to her new life and its relative purposelessness. Mercifully, her elderly husband’s fragile nerves lead to his death rather early on in the book. Her logical outlook and altruistic nature render her a perfect supporting character and help her to keep a clear purpose in sight, even if it isn’t the one she initially set up for herself. She is adaptable, sensitive but not over-emotional, sensible, nurturing, and has just the right about of independent flare — not enough to make her disobedient, but enough for her to harbor her own thoughts and impressions, which she shares openly and honestly. She instigates communication between characters who are otherwise unable to come to terms with one another throughout the story, which is facilitated by her constant desire to maintain harmony amongst her friends and neighbors.

Starkly contrasted with Dorothea’s selfless desire to mold herself in a way most helpful to those that surround her, Rosamond Vincy’s perspective is smaller and more self-centered. Her role as a woman is to be supportive, but she directly contradicts her husband’s wishes on multiple occasions, going so far as to foil his plans for relocating to a smaller house without his knowledge. She was raised in the wealthy and well-thought of Vincy family, and spoiled from a young age, is ill-equipped to deal with the change in lifestyle that will accompany marriage to a physician-scientist. Unlike Dorothea, who adapted her lifestyle and purpose to support her husband’s, Rosamond fails to see the value in Dr. Lydgate’s intellectual pursuits and wonders why he doesn’t go into a more lucrative facet of medical practice in order to suit her extravagances. The couple spend a good portion of the second half of the book at odds with one another, but the good doctor takes his duties as a husband more seriously than those of a scientist in the end; he sacrifices his research to support his self-centered wife.

By foiling Rosamond with Dorothea, Eliot presents two different versions of womanhood. Dorothea supports her husband, submitting her mind and enlisting its genius in the wholehearted pursuit of making her husband (both of them) successful. Her second husband is quite successful, and Eliot makes it clear that this is largely a result of the support he receives from his love interest and later wife. Even during the first half of the book when he is hopeless — Dorothea is married to his benefactor and then forbidden to marry him legally — his desire for her positive opinion drives him to achieve. Rosamond, on the other hand, uses her feminine wiles to seduce the young, well-meaning doctor, full of potential as a scientist. After marrying him, she perverts his utilitarian goals, insisting instead that he support her needlessly expensive lifestyle. Instead of encouraging him to do what he loves for the betterment of all, Rosamond insists that he modify his purpose to her own, selfish ones.

Thus, the willful, unyielding woman led to the intellectual death of the noble, utilitarian scientist. I wonder if there isn’t some commentary here on the role that women should play in science — supporters of the real movers and shakers, but certainly not active participants.

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