Welcome to July, Middlemarchers! In my edition we’re officially more than halfway through the book, even including the many pages of endnotes at the back of the book. Thank you for all of your comments and questions these last 6 months, it’s been a blast so far!

Summary

Once again, the Middlemarch rumor mill puts Lydgate’s reputation at risk. A few people in Middlemarch suspect that Lydgate intends to let the patients at the new hospital die on purpose so he can dissect their bodies. He did in fact ask the family of one of his patients if he could dissect her body, as it seems her symptoms were unusual, but this offends her family and many of her neighbors.

The debate about “medicines” (i.e. pills, draughts, and other prescriptions) comes back with a vengeance. In the 1830s, most doctors outside of London didn’t actually charge for the time spent attending to patients, but only for the drugs they prescribed. Lydgate accidentally offends the grocer Mr. Mawmsey by saying that doctors’ overreliance on selling drugs to make their living leads them to overprescribe remedies that don’t actually help, or that can actually harm the patient. Mawmsey has paid for his fair share of medications over the years, and soon word is spreading through the town that Lydgate said that medicines don’t do anything at all.

This, of course, annoys the other doctors in town, including Dr. Toller and Dr. Wrench, who both prescribe drugs. Toller predicts that Lydgate’s reforms won’t work, because his patients want to be prescribed remedies. But Mr. Lydgate’s anti-interventionist strategy pays off for a few high-profile patients, including Mr. Trumbull and Fred Vincy. He even correctly diagnoses and cures a patient whom Dr. Minchin had misdiagnosed as having a tumor. This helps his reputation in the town at large, but turns the other doctors against him.

His alliance with Bulstrode doesn’t help matters. The other doctors in town view them both as arrogant charlatans, and refuse to attend to patients in the new fever hospital. Lydgate and Bulstrode are forced to hire doctors from neighboring towns, but Lydgate is confident that eventually the other Middlemarch doctors will come around. His friend Mr. Farebrother cautions him not to get too close to Bulstrode, and also warns him about the dangers of debt. Mr. Lydgate has recently gone into quite a bit of debt due to his marriage to Rosamond, but he views this as inevitable and isn’t overly concerned.

Lydgate is still committed to his ambition of making a major medical discovery, and compares himself to Vesalius, a 16th century anatomist who stole the bodies of criminals to conduct research. Rosamond is concerned that his reputation in the town has been irreparably damaged, and opines that his rich relatives consider him a disappointment. Lydgate is offended that she does not see the value of his profession, but they eventually come to an uneasy truce.

References

There are several references to Burke and Hare in this chapter. William Burke and William Hare murdered 13 people and sold the bodies to anatomist Robert Knox, who used them for dissection. Hare was granted immunity when he agreed to supply the Crown with evidence, but Burke was tried for murder in 1828, found guilty, and hanged. The trial raised awareness about the shortage of bodies for medical dissection and the common practice of doctors making deals with graverobbers and murderers to obtain bodies. The Anatomy Act of 1832 required licenses for anatomists. It allowed those with a license to dissect bodies donated willingly by a deceased person or their family, as well as unclaimed bodies from prisons, workhouses, and hospitals. The bill effectively ended the practice of graverobbing and murdering to obtain bodies for dissection, but remained controversial for many years, particularly because many poor people had their bodies dissected without their consent.

Mr. Gambit is a renowned acoucher in Middlemarch. An accoucheur is a male midwife.

There are several references to medical treatments and conditions throughout the chapter, including “depletion” (the practice of reducing the fluid contents of an organ), “erysipelas” (an infectious skin condition), “squitchineal” or “quitchineal” (colloquial terms for cochineal, a crimson substance used for dyeing and also as an antispasmodic), and “blister” (a plaster used to raise a blister).

When Middlemarchers are discussing charlatans, several of them mention St. John Long, a quack doctor who was tried on two separate occasions for killing his patients.

Lydgate compares himself to Raspail and Vesalius. François-Vincent Raspail was a contemporary French chemist and physician whom Lydgate feared was outracing him in conducting similar research, and Andreus Vesalius was a Flemish anatomist in the 16th century who had to steal bodies for dissections, but who made major discoveries about the human body, particularly concerning the vascular and circulatory systems.