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Trollope's doctors

Anthony Trollope's Doctors

Rodney Turner

 

This was written in 2000 as a talk for the Trollope Society in London and subsequently published in their magazine the Trollopian. You can find out more about the Trollope Societies on an excellent page from the Victorian web, produced by George Landow from Brown University. The organisation in the USA also has its own US Trollope Society website

 

The professions in Trollope's novels Did Trollope dislike doctors?
Medicine in Trollope's England ... probably he did
Illness and death in the novels  

 

I retired from full-time work twelve years ago, and was once again able to enjoy the pleasures of leisurely reading. I had read the Barchester novels long ago, and memories of Trollope's skilful story-telling, which left me constantly eager to know what was going to happen on the next page or in the next chapter, caused me to join the Trollope Society. I worked my way through the novels as they appeared, and while doing so I was struck by an anomaly that I could not at first explain.

 

The professions in Trollope's novels

In Trollope's time, three professions - the church, the law and medicine, were known as "learned" because they were based on a classical education. Among the great number of characters featured in his 47 novels were members of all three professions. Clergymen and lawyers often play an important part in the narrative, and their personalities, circumstances and families are explored and analysed. Some are good, others are dull but worthy, and a few are evilly disposed, but whatever part they have to play they are usually so fully described that they fit into the story and into the society of which their author wrote.

Trollope's doctors are not like that. With one notable exception, they are not prominent in the narrative. More than ninety feature in the novels, making them almost numerically equal with the lawyers, but only half are named and few even among these achieve more than a brief mention. For the most part they are introduced into the narrative for a specific purpose: they visit the sick, treat injuries which often result from a fall in the hunting field, and are present at deathbeds. Their work done, they are discarded and rarely reappear.

I wondered why Trollope should be so dismissive of his doctors, and why one learned profession should be relatively neglected. He must have been familiar with doctors, for although his own health was robust for most of his life, the same was not true of his close relatives. Like most large families in Victorian England, the Trollopes had their share of misfortunes. Two of Anthony's brothers and two of his sisters died young. His brother-in-law married after the death of his first wife, but his second wife and four of his children died too. He married for the third time, and a child of this marriage died too. Trollope's surviving brother lost his wife at the age of 42, and their daughter died when she was 28. Their father suffered from chronic ill-health, probably had a paranoid psychosis, and spent his last years as a total invalid. Doctors must have been frequent callers at Trollope households and Anthony must have witnessed or heard about their visits many times, but the ailments from which the family suffered, among them tuberculosis, death in childbirth and psychiatric illness, were all unresponsive to treatment. Repeated encounters with doctors must have been both dispiriting and costly, and as an intelligent man Trollope cannot have avoided forming strong opinions about contemporary medicine and its practitioners. Before investigating how he wrote about the illnesses and deaths of his characters, and assessing his fictional doctors, it is helpful to review the state of medicine and the social status of its practitioners during his writing career.

 

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Medicine in Trollope's England

In the early nineteenth century, British doctors were deployed in a hierarchy which had undergone little change since medieval times. The elite of the profession, not least in their own esteem, were the physicians. They were graduates of Oxford and Cambridge universities, where they had studied the classics, botany and materia medica (today's pharmacology), and were communicants of the Church of England. Their Royal College of Physicians had been founded in 1518, nearly three hundred years before. They held a monopoly of practice within a seven mile radius of the city of London, admitting only those applicants to practise there who passed an oral examination conducted in Latin. Although they remained pillars of the establishment, their College had become little more than a fashionable gentlemen's club, and increasing numbers of aspiring students obtained their medical qualifications at enlightened universities in France, Germany, Holland or Scotland.

Below the physicians came the surgeons. They separated from the barber surgeons in 1745 to found their own company, which was raised to the status of a Royal College in 1800. They were a disparate group, for although some been educated at university, most had merely served as apprentices to senior colleagues and this, plus knowledge of anatomy, was all that was required of them in order to practise surgery, still widely regarded as an apprenticed craft. For many, surgery was a part-time occupation, and much of their work was similar to that of apothecaries.

The apothecaries occupied the bottom rung of the profession. Their origins were in trade, and many of them combined the sale of drugs with other occupations. They had some knowledge of chemistry and botany, and knew enough Latin to dispense physicians' prescriptions. In 1617 James I permitted the Society of Apothecaries, previously contained within the Company of Grocers, to issue licences to members who had served an apprenticeship and had worked in hospital, but they were not differentiated in any other way from unlicensed practitioners. Their part in health care was shared in a free-for-all competition with herbalists, bonesetters, clergy and an assortment of others including an army of charlatans and quacks.

At the dawn of the nineteenth century medical care was not so much organised as in a state of unregulated chaos. But changes were imminent. The first of these took place in 1815, the year of Trollope's birth, when Parliament passed the Apothecaries Act. This legitimised the right of licensed apothecaries to be recognised as doctors, and marked a significant step in the evolution of the general practitioner, as the new breed became known. But most GPs came from unprivileged backgrounds, and their modest origins were not forgotten. Doubts about their competence, and confusion over their social status, persisted. The term "apothecary" was used long after 1815 by critics to express a suspicion that GPs were an inferior breed and not properly qualified. Even after the General Medical Council was set up forty years later to register all doctors and to investigate allegations of misconduct, unregistered individuals were still allowed to advertise their services to the public.

The number of GPs rose rapidly, and for many life was hard. Often they were unable to marry until 40 years old or more unless private means enabled them to buy a practice. Most had to wait until a senior partner died or retired, meanwhile doing most of the work for a meagre reward and supplementing their income by attending workhouses or Poor Law institutions. The medical historian Roy Porter has described the nineteenth century GP as "a highly vulnerable individual in a competitive buyer's market in which it was not uncommon to undercut each other or to poach patients . For an outsider, the prospects of rising up the profession to become a top consultant were negligible; such eminences still came largely from a self-selecting and self-perpetuating few." By contrast, doctors who became society favourites or acquired a good reputation could gain great wealth and recognition; between 1850 and 1883 36 doctors were knighted, 15 became baronets, and one was granted a peerage. This wide variation in fortune and material prosperity caused uncertainty and confusion in the minds of many, and doubts over whether a doctor could be accepted as a true gentleman are often reflected in contemporary fiction.

An explosion in scientific knowledge and understanding began early in the century and continued unabated thereafter. The germ theory of infection, the identification of cellular changes as the basis of pathology, the use of the stethoscope, the development of anaesthesia and the introduction of antiseptics in surgery were among the medical advances, all ultimately benefiting the public health, which occurred during Trollope's active career. Of greater immediate importance were social measures such as the Public Health Act, pioneered by Edwin Chadwick (a lawyer), which brought about improvements in the quality of the water supply and in the efficient disposal of sewage.

Unfortunately, the benefits of new ideas and techniques were slow to percolate through to everyday medical practice. GPs were handicapped by the deficiencies of an inadequate and basically faulty education. Professionally isolated, and beset by eager and often unscrupulous competitors, they had few opportunities and little incentive to change their style of practice. They relied instead upon experience, which all too often involved repeating the same mistakes with increased assurance, and upon the cultivation of a reassuring manner, resorting to medical jargon and Latin phrases to conceal any doubts they may have felt. Examination of their patients was generally limited to feeling the pulse, inspecting the tongue and observing the features, after which an opinion and advice were given. Unable to influence the course of most illnesses, GPs could easily worsen matters by injudicious advice or inappropriate treatment. Thus the potential benefits of social and medical advances were rarely translated into a better service for the public. The average expectation of life at birth increased only modestly, from just under 40 at the beginning of the century to 44 at its end, when the infant mortality rate was actually higher than it had been at any time: during the previous sixty years. In some inner city districts more than half of all babies born died before their first birthday. Infectious diseases nourished in the overcrowded and unhygienic conditions in which most people lived, especially in rapidly expanding industrial centres and in remote rural areas. Poverty and ignorance were rife, malnutrition widespread, contraception was rudimentary and large families the rule.

 

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Illness and death in the novels

This was the state of affairs during Trollope's writing career. As he was familiar with doctors, there may have been other reasons why they play such minor parts in his stories. If he simply lacked interest in medical matters, there should be evidence of it. His novels include such a huge cast of characters that there are inevitably many episodes involving illness and death. Generally he handles deathbed scenes with restraint, giving few clinical details. Old men, especially if they have an inheritance to leave their heirs, are allowed to fade peacefully away. Some individuals who might have been expected to have much more to contribute to the tale are despatched summarily. Glencora, Duchess of Omnium, and Eleanor Bold's first husband, John, both disappear between volumes with scant explanation, while Mrs Proudie dies with shocking suddenness. Pregnancy and childbirth also receive short shrift. Despite appallingly high current rates of maternal and childhood mortality, most of Trollope's heroines produce healthy children. There are exceptions: Feemy McDermot (The McDermots of Ballycloran) miscarries in public, dying herself in improbably undramatic fashion, while Kate O'Hara (An Eye for an Eye), pregnant, unmarried and deserted by her lover, flees to France, where "Fate spared her the burden and despair of a living infant." As three-quarters of illegitimate babies born in London in the Victorian era died in the first year of life, such an outcome would have been regarded as unregretted and almost inevitable.

Tuberculosis, a major cause of chronic illness and premature death in Victorian England, is invoked surprisingly rarely as a cause of sickness. Of the Eustaces (The Eustace Diamonds) Trollope writes, "Consumption had swept away a hecatomb of the family", a comment he might have made about his own close relatives. An eponymous heroine, Marion Fay, believes correctly that she is destined to follow her mother and five siblings in dying from the disease. Her demise follows a slow, serene, almost surreal decline. There is no mention of the distressing symptoms which commonly accompany advanced consumption: the pain, fever, sweating, restlessness, weariness and emaciation. Yet these features must have been familiar to Trollope. His brother Henry's last months were marked by furious anger, bursts of frenetic activity and periods of collapse and despair. Perhaps these memories were too vivid and painful for the author to recall, so perhaps he feared that they would upset his readers if his account was too realistic.

By contrast, the effects of venereal disease are related in vague but lurid detail. Victorian delicacy prevent. him from being explicit, but a discerning reader would understand the implication of his accounts of its victims. Curiously, most of them are noblemen including one, Lord Lovel (Lady Anna), who goes mad, Trollope commenting grimly that "men who make women a prey, prey also on themselves." Nor are their offspring spared; the putative little Lord Popenjoy, "a rickety brat", is one of several infants doomed to die from what is clearly congenital syphilis.

In writing about a third chronic medical problem, the abuse of alcohol, Trollope loses all inhibitions. Of Louis Scatcherd (Dr Thorne), dying, like his father, from alcoholism, he declares, "Every organ was destroyed, or in course of destruction . I will not disgust my readers by attempting to describe the poor wretch in his misery." He then proceeds to do exactly that, giving a lengthy though clinically inaccurate account of Louis's condition. There are similar passages in other novels. He is especially severe on overindulgence in gin, which was cheap and much favoured on that account by the poor. Winterbones, the Scatcherds' confidential clerk, is "a little, withered, dissipated, broken-down man, whom gin and poverty had nearly burnt to a cinder, and dried to an ash." A long account of the state of Mary Snow's father (Orley Farm), another gin drinker, ends, "I do not know whether such a man as this is not the vilest thing which grovels on God's earth." Why Trollope should have relished such purple passages is not clear. He may have enjoyed letting himself go, or perhaps he felt that alcoholism was reprehensible since it could be prevented by exercising self-control, and that moral judgements would be popular with his readers. This may also have been his motive for summing up Louis Scatcherd's condition by declaring, "If any father have a son whose besetting sin is a passion for alcohol, let him take his child to the room of a drunkard possessed by the horrors. Nothing will cure him if not that."

Hospital medicine is entirely absent from Trollope's fiction. Even John Scarborough (Mr Scarborough's Family), a probable cancer sufferer, is operated on in his own home. This would not have been considered foolhardy, for hospitals were still regarded by many as dangerously unsafe places, and those who had the means to avoid them often did so.

This brief summary should dispel any idea that Trollope lacked the will to describe organic complaints. The selective process which determined the amount of clinical detail in his descriptions of illnesses may have been the result of his own sensitivity or perhaps his ignorance of the facts. But in writing about psychiatric illness his methods were very different. Minor emotional disorders occur frequently in his novels, young women being especially prone to weakness and faintness, headaches and loss of appetite. Their plight usually results from disappointment in love, Trollope leaving the reader in no doubt about its cause. His accounts of these incidents are often very funny, though there is sometimes an undercurrent of unease lest the illness may progress to the dreaded consumption. Thus when a doctor examines the lovelorn Katie Woodward (The Three Clerks), he remarks ominously that "there is no organic disease ­ yet." Fears of dying from a broken heart, however, though often expressed, are not always to be taken seriously, and a prize for melodrama should surely be awarded to Grace Crawley. Overcome by shame when her father is accused of stealing a cheque, she declares, "it would kill her father, and after that it would kill her mother, and after that it would kill her." Her sentiment is echoed by her potential father in law, Archdeacon Grantly. Informed that his son wishes to marry Grace, he exclaims, "I think it would kill me; by heavens, I think it would be my death."

But serious mental illness is taken seriously. It is not dealt with vaguely and inaccurately, like organic ailments, nor with the levity with which minor emotional problems are treated. Trollope's account of Josiah Crawley's despair could be read as a classic description of paranoidal depressive illness, and the obsessive conjugal jealousy of Louis Trevelyan (He Knew He Was Right) and Robert Kennedy (Phineas Finn) are equally perceptive portrayals of delusional states. The suicidal anguish of Ferdinand Lopez (The Prime Minister) is brilliantly depicted. Lopez is followed through the eyes of a railway porter, who becomes increasingly perturbed as he sees him moving dangerously close to the edge of the station platform each time a train approaches. Lopez, terrified, irresolute and despairing, hesitates time and again before taking the fatal steps: on to the line. It is horrifyingly realistic: Trollope certainly had the measure of suicidal desperation.

Nineteenth century psychiatry had little to offer mentally ill people. When Mrs O'Hara murders Fred Neville (An Eye for an Eye) and is admitted to a mental hospital, Trollope writes, "The reader need not fear that he is to be asked to loiter within the precincts of an asylum for the insane. Of this abode of wretchedness no word more shall be said." Sir Thomas Fitzgerald (Castle Richmond) is so depressed that he feels that "there is nothing left but to turn his face to the wall and die", and his physician, echoing Shakespeare, "could only feel, whatever he might say, how impossible it is to minister to a mind diseased." Sir Thomas Underwood (Ralph the Heir) lives with "that inner feeling of almost insupportable mortification which comes from the conviction of personal failure." The man who wrote this said of his own father, "the touch of his hand seemed to create failure ... his life as I knew it was one long tragedy." His father's illness cast a long shadow, giving Trollope remarkable insight into the dark moods of the depressed.

 

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Did Trollope dislike doctors?

So there is ample evidence to show that Trollope was not averse to describing the physical and mental sufferings of his characters when it seemed relevant and important to do so. There remains another possible reason for his neglect of doctors; a distaste for and perhaps a dislike of the profession and its members. So what of the doctors themselves? Apart from Dr Thorne, they are mostly relegated to the role of bystanders. Few play a significant part in the plots. John Bold (The Warden) is "brave, eager and amusing; well-made and good-looking, young and enterprising, his character is in all respects good." This is a promising start, but Bold is more active as a gadfly in local affairs than in his profession, and after his sudden death off-stage there are no backward glances in his direction. James Crofts (The Small House) has one function only, to marry Lily Dale's sister, and is otherwise insubstantial and uninteresting. Neither of these two, though they are briefly significant, survives for long in the memory or in the text. In all the novels there are few favourable references to doctors at all. Dr Malachi Finn (Phineas Finn) "had not a penny for which he had not worked hard." Dr Shand (John Caldigate) is "a physician enjoying a considerable amount of provincial eminence in Essex." Albert Fitzallen (Orley Farm) is "an apothecary ... quite a genteel young man, and very respectable in the medical line." To stray briefly into Trollope's short stories, he wrote of Dr Dugdale (Alice Dugdale) "I do not know that he was very great as a doctor, - but he was a kind-hearted, liberal man", while Dr Gresley (Mary Gresley) "as he seemed to have been called without any proper claim to the title, had been a diligent man and fairly successful." These perfunctory tributes all sound a trifle lukewarm.

In contrast, disparaging comments about doctors are frequent. Dr Colligan (The KeIlys and the O'Kellys), ironically referred to as the Galen of Dunmore, receives much attention. Extracts from a lengthy description of his shortcomings include, "A tall, thick-set, heavy man ... a little bald . . He looked as though he had shaved the day before yesterday, and had not washed since ... many things about (him) were not calculated to inspire either respect or confidence ... he had an air of doubt and indecision ... excessively dirty in his person and practice would wipe his hands on the patient's sheets ... smelt equally strongly of the stable and the laboratory ... very fond of eating and drinking ... liked his daily glass, or three or four glasses, of sherry ... ignorant of everything but his profession, and the odds on the card-table or the racecourse." It would be interesting to know who was the model for this unattractive figure.

Laura Kennedy (Phineas Finn) thinks her doctor "a horrid little man pawing me and covering everything with snuff ... I hate Dr Macnurthrie." Dr Napper (The American Senator) rides to hounds, strategically placed at the back of the field so as to be quickly on the scene of any lucrative falls; he has a conspicuously red nose.

Then there is Dr Fillgrave. He has the best practice in Barchester, where he leads an anti-Thorne faction, for Dr Thorne's relations with his colleagues are strained. They disapprove of his style of practice and scorn his "low, mean, unprofessional and democratic" conduct in charging what they consider the unacceptably low figure of seven shillings and sixpence for visiting patients, and also for dispensing medicines himself. Fillgrave "dearly loved a five pound fee, to which Trollope adds innocently, "what physician is so unnatural as not to love it?", yet despite this, he expresses hatred for the personal "contamination of a fee." He adheres to the "guinea fee, the principle of giving advice and selling no medicines, the great resolve to keep the distinct barrier between the physician and the apothecary ... a physician should take his fee without his left hand knowing what his right hand was doing." Yet Thorne's erosion of professional boundaries is little different from that of Fillgrave himself who, in a telling phrase, is "accustomed to meet, on almost equal terms, the great medical baronets from the metropolis at the houses of the nobility."

Trollope pours all his scorn and derision into Fillgrave, mercilessly lampooning him as an absurdly pompous figure: "not tall ... perhaps more inclined to corpulence than became his height ... he had a little round abdominal protuberance, which an inch and a half added to the heels of his boots hardly enabled him to carry off as well as he himself would have wished." His presence at deathbeds "adds grace to the hour of departure", while his prediction of an imminently fatal outcome by a slow downward movement of his hands and a declaration that '"we are all dust" is alone thought to be worth the fee for his attendance. Regarding the dying Septimus Harding, he remarks, "he has no suffering, no pain ... Nature simply retires to rest." In a similar vein, Dr Powell says of Indefer Jones (Cousin Henry) that "He was a worn-out old man ... the candle had nearly burned out in the socket." Even eminent physicians resort to similar pious utterances. Sir Omicron Pie, attending the moribund Duke of Omnium, explains that "the vital spark is on the spring", accompanying this consoling reflection with a heavenward gesture, and when called to see Mr Bertram (The Bertrams) he simply shakes his head and says that "the fiat had gone forth."

These passages provide clear evidence that Trollope recognised the impotence of doctors to affect the course of most illnesses, and ridiculed their recourse to platitudes to disguise their helplessness. Sir Omicron's instructions that the dying duke should be rationed to "no more than a glass and a half of champagne a day" and allowed no visitors to his sickroom are ludicrous, and no more than an attempt to be seen to be doing something. He is referred to several times, surely ironically, as "the great London physician" and once, more slightingly, as "the little doctor." Countess de Courcy (The Small House) hopes that Sir Omicron will advise her bad-tempered husband to go to a German spa and relieve her of his presence for a while, an echo of the feelings of Trollope's mother when she wrote to a friend expressing her relief when her husband absented himself briefly from his family. Like Fillgrave, Sir Omicron, despite his reputation, is revealed as a pompous ass who never appears to do any of his patients any good. Beneath Trollope's humour there is a sense of real anger, perhaps based on recollections of futile and frustrating past encounters.

 

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... probably he did

Molly Gibson, the heroine of Mrs Gaskell's Wives and Daughters, is a kind, well-meaning doctor, while George Eliot's Tertius Lydgate (Middlemarch) is a heroic figure, a conscientious GP beset by domestic turmoil and the antagonism of jealous colleagues. In the same novel an aristocratic woman remarks, "For my part, I like a medical man more on a footing with the servants." Miss Thorne, who says to Mary Bold, about to visit her doctor because of her small son's illness, "Make sure the man knows what he's about and doesn't destroy your little boy ... Any whippersnapper out of an apothecary's shop can now call himself a doctor ... no education is thought necessary", could not have put it more clearly. Whether Trollope's contemporaries shared the opinions I have attributed to him I can do no more than speculate, but it was not until the twentieth century that Brett Young, Cronin, and Mills and Boon made the lives and loves of doctors of absorbing interest to the reading public.

Trollope must have experienced many occasions when doctors recommended treatment for his relatives or friends, treatment that was often costly and almost always useless, while disguising their impotence in a stream of pompous platitudes and following each visit with the inevitable demand for a fee. It is fair to assume that the unflattering depictions of his fictional doctors were drawn from real life. It is not difficult to understand why he may have viewed lawyers, clerics and others as more worthy of detailed study.

 

 

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