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« Remaining George Eliot | Main | Becoming George Eliot »

The Medical Profession in MIDDLEMARCH

Suffice it to say, the early nineteenth century brought vast changes to the medical profession in Britain and on the Continent.

In MIDDLEMARCH itself, Eliot is careful to describe medical practice in the early 1800s, although some of the smaller, political battles may seem rather arcane today.

Among the more prominent in the novel are those of the banker Bulstrode. He wants to be the Oral Roberts of his day: to build a hospital with a modern medical practice and a strong spiritual component, mostly of the Evangelical, low-church, Protestant type, much as Roberts did in Tulsa in the mid-1980s.

Before 1815 or so, hospitals were truly little more than insane asylums or nursing homes, designed to house the mentally ill, those so chronically ill as to be at death's door, or the old and indigent. In other words, hospitals were warehouses--as in Hiram's Hospital in Trollope's THE WARDEN, a novel we read a while back. If you went into hospital, you did not come out until you were dead.

In MIDDLEMARCH, the nature of the hospital is changing to its modern definition. What Bulstrode wants to build is what we would call a clinic with overnight or short-term-care facilities. The mere notion of such an institution is a radical change, even without his wanting to proselytize as well.

In the years leading up to the opening of the novel, the medical profession was distinctly a middle-class affair. The gentry, the London quality, and even well-to-do farmers did not become doctors. Nor their sons. Period. The whole medical practice was thought to have more than a whiff of the bourgeois about it. In fact, most people in the burgeoning middle class and certainly all in the upper class looked down on doctors, about as they would on farriers. Doctors were technicians. They provided a function, a service. In the best of cases, they forestalled death; in most, they hastened it.

However, when the novel opens, things are beginning to change. We're right on the cusp.

As to the staff of Bulstrode's hospital, he'll still need to work in the existing medical profession. At the time, it was divided into three classes: physicians, surgeons, and apothecaries. Of the three, physicians could most often pass for gentlemen. Most went to Oxford or Cambridge. Their education was almost without practical training--which would have sullied them as gentlemen. Indeed, a physician's course of study involved extensive lessons in Greek and Latin--and relatively few in anatomy. They were, to be blunt, bed-sitters.

Surgeons and apothecaries did the work--and were not considered gentlemen. They did not go to university. They trained as apprentices. Surgeons did the cutting, the actual procedures: pulling teeth, bandaging wounds, etc. Apothecaries dispensed medicines, potions, tinctures, and salves. They also carried baking supplies (baking soda, for example), most herbs for cooking, all spices (you went to an apothecary to get cinnamon, for example), beer-making equipment, and household cleaning supplies. If it was chemical, apothecaries handled it. Because of their lower fees (and despite their stigma as working-class men, their better knowledge), they were often sought out by middle- and lower-class people to stand in for physicians.

British apothecaries were completely unregulated until the Apothecary Act of 1815, the first reform act aimed at the medical profession. Before 1815, apothecaries and physicians (or to a lesser extent, surgeons) were in a cosy relationship, often lining each other's pockets. They set up proprietary relationships--if you see Dr. So-and-So then you must use his apothecary--and some apothecaries cornered the market on certain medical supplies. Lydgate, if you remember, wants to break the relationship apart--and so is none too popular with the old guard.

He stands in an unusual position, a thoroughly modern one. He was apprenticed early on--and so would have been destined to be a surgeon. But he then attended school at Edinburgh and Paris, the two finest medical establishments of their day. (Paris was peerless as a center for medical knowledge.) Several characters remark on the fact that Lydgate wants to blur the lines between bedside-sitting physician and active surgeon. Such a blurring is quite radical--mostly because it blurs established class lines.

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