Middlemarch

Middlemarch

by

George Eliot

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Middlemarch: Book 5, Chapter 45 Summary & Analysis

Summary
Analysis
A rumor spreads that Lydgate intends to let patients at the New Hospital die on purpose so he can use their cadavers for medical experiments. Lydgate’s decision not to sell medication to his patients himself is also seen as highly suspicious, partly because only London doctors are considered worthy of charging for their services, rather than just earning money through the sale of drugs. In a conversation with the grocer Mr. Mawmsey, Lydgate explains that the existing system leads to doctors overprescribing useless medicines in order to earn a living. Following this conversation, townspeople begin saying that Lydgate claims medications themselves are useless.
This passage encapsulates how Lydgate’s attempt to bring necessary medical reform to Middlemarch gets misinterpreted and turned into a spectacle, creating widespread hysteria. Though Lydgate’s explanation of why doctors shouldn’t sell medications is both clear and reasonable, people in Middlemarch are so resistant to change that they perhaps deliberately choose to misunderstand it.
Themes
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Mr. Hawley advises Mr. Wrench and Mr. Toller (to their disappointment) that the law cannot be used to stop the kind of medical reforms Lydgate is pushing. Mr. Toller declares that it doesn’t matter; patients themselves will object to Lydgate’s refusal to dispense drugs, and thus the practice is doomed to fail. Toller is at least half-correct: many people are skeptical about the treatment they will receive from Lydgate. At the same time, Lydgate heals a great many people, including those whom the other local doctors had tried and failed to cure. The suspicion over his attitude toward medication begins to subside. 
This passage takes a more hopeful turn, suggesting that even conservative, suspicious communities can be brought around to reform through seeing the evidence themselves. At the same time, it is not just patients that Lydgate has to persuade; it is also the hostile community of existing doctors who are personally invested in seeing him fail, even if this means more people in Middlemarch suffer and die as a result.
Themes
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When Mr. Trumbull contracts pneumonia, he asks Lydgate to treat him. Lydgate suggests that Trumbull’s “robust” nature means he would be a perfect candidate for allowing the disease to work itself out, without the intervention of medication. Trumbull consents, and after healing from his illness declares that Lydgate is by far the best doctor in the area. All of this happens before Lydgate cures Fred’s fever. Farebrother is a vocal defender of Lydgate but, paradoxically, is also known as “a chief flag of the anti-Bulstrode party.”
Lydgate’s struggle to stop overprescribing medication is fascinating from a contemporary perspective. We might assume that the over-prescription of medicine is unique to our age, a creation of “Big Pharma.” In reality, this problem has existed at least since the early nineteenth century, suggesting that it is very deeply rooted and may be difficult to change.
Themes
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The New Hospital will be dedicated to fever. Lydgate will be “chief medical superintendent” with final decision-making power. Every doctor in Middlemarch refuses to work at the hospital, so Lydgate hires people from elsewhere. The Middlemarch doctors do not oppose Lydgate’s medical work so much as his supposed showiness and “arrogance.” Both he and Bulstrode are accused of being “charlatans.” Meanwhile, Farebrother advises Lydgate to be careful about money.  
Again, opposition to Lydgate and the New Hospital has no legitimate foundation. Instead, it is rooted in petty jealousy, conservatism, and spite—as well as distrust of Bulstrode because of his religion and lack of family connections.
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That evening, Lydgate tells Rosamond about an anatomist named Vesalius who lived in the 16th century. He had to secretly steal corpses in order to conduct his research, and was vilified as a result. However, he made major discoveries about the human body. Rosamond confesses: “I often wish you had not been a medical man.” This upsets Lydgate, as being a doctor is such an integral part of him, and thus he feels like Rosamond does not truly love him for who he is. Rosamond teases him and he lets it go.
This passage confirms that Rosamond did not marry Lydgate for who he was, but instead constructed a fantasy about him and the life they would lead together. She was so convinced by this fantasy that she ignored even the most basic facts about Lydgate’s personality. This shows how after marriage people can become strangers to each other. 
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