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Trollope+Eliot 2

Part 2 of of Trollope, Eliot and Their Doctors by Rodney Turner.  Go to Part 1 More information about the author.  

Fictional Illness

Trollope’s novels feature about ninety doctors, but apart from one exception they are not as prominent as either clerics or lawyers. Accounts of illness and death are generally handled with restraint. Old men, especially if they have an inheritance to leave their heirs, fade peacefully away, while some characters who might be expected to contribute more to the narrative are despatched summarily; Glencora, Duchess of Omnium (The Duke’s Children) dies before the story begins, while Mrs Proudie (The Last Chronicle of Barchester) dies with shocking suddenness from a heart attack.

Pregnancy and childbirth receive little attention: Trollope’s heroines produce healthy infants despite the high mortality rates of the day, though there are exceptions. Feemy McDermot (The McDermots of Ballycoran) miscarries in public, dying in improbably serene 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 be considered unremarkable.

Trollope could hardly have avoided mentioning tuberculosis in view of its widespread prevalence, not least in his own family. The Eustaces (The Eustace Diamonds) “had all been short-lived. Consumption had swept away a hecatomb of the family.” The eponymous Linda Tressel grew “weak and sick . . . thinner and paler, paler and paler.” Her doctor “could only shake his head and speak in whispers . . . all her earthly troubles were brought to a close.” Another eponymous heroine, Marion Fay, knows that she is destined to follow her mother and five siblings in dying from the disease. There are some early warning signs. “Occasionally there would be heard from her that little preparation for coughing which has become so painfully familiar to the ears of those whose fate it has been to see their beloved ones gradually fade from perfect health.” Marion’s decline is slow and serene. There are none of the distressing symptoms of advancied consumption – pain, fever, sweating, restlessness, weariness, emaciation – though they must have been familiar to Trollope himself. His brother Henry’s last months were punctuated by bouts of furious anger and frenetic activity followed by collapse and despair. Perhaps these memories were too painful to recall, or perhaps Trollope felt the true picture was too shocking to describe. In a short story, Christmas at Thompson Hall, he touches briefly on a tuberculous patient’s suffering: “Who does not know that sound, almost of two pieces of rusty iron scratching against each other, which comes from a suffering windpipe?” This suggests that he knew of the agony of tuberculous laryngitis, for this short passage bears the sincerity of personal grief.

Fear of his readers’s sensitivity may have prevented Trollope from detailing the effects of venereal disease too explicitly, but discerning readers would understand the implications of his accounts of its consequences. One victim, Lord Lovel (Lady Anna), goes mad,Trollope commenting grimly that “men who make women a prey, prey also on themselves.” The evil Marquis of Brotherton (Is He Popenjoy?), of whom “it had been the resolution of his life to live without control”, dies at the age of forty-three. His son, the putative little Lord Popenjoy (“a rickety brat who was doomed to die”) had predeceased him, dying from what was clearly congenital syphilis. The infant son of Hugh Clavering (The Claverings) is likewise “a poor, rickety, unalluring bairn”, while in the same work Lord Ongar is “weak, thin and physically poor . . . whispers spread about darkly.” Cuthbert Norman (The Three Clerks) led a life “stained with debauchery . . . his health had broken down, and he was now tottering to an early grave.” Sir Gregory Marable (The Vicar of Bullhampton) is “over forty but looked sixty . . . a confirmed invalid, a man already worn out, old before his time, and with one foot in the grave . . . unfit for life.” Sir Patrick Carbury (The Way We Live Now) is “a worn-out, dying invalid”, while his son, Sir Felix, “led a life in every way very bad - every vice might be forgiven in a man and a son, though every virtue was expected in a woman.” The name of Onesiphorus Dunn (Last Chronicle), known to his friends as Siph, speaks for itself.

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But on alcohol abuse, Trollope abandoned all inhibitions. Sir Roger Scatcherd (Doctor Thorne) ignores his doctor’s warnings about his heavy drinking. Thorne berates him, declaring, inaccurately but with understandable frustration, that “the blood is beating round your brain with a violence that would destroy any other brain but yours.” Scatcherd continues to drink and dies miserably. His son, Louis, follows an identical path to self-destruction. Trollope writes of his last hours, “I will not disgust my readers by attempting to describe the poor wretch in his misery.” He then does precisely that, giving a lengthy account of Louis’s suffering. Elsewhere, he is particularly severe on gin-drinking: 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.” The description of the gin-addicted father of Mary Snow (Orley Farm) ends, “I do not know whether such a man as this is not the vilest thing which grovels on God’s earth.” The connection of gin with poverty, the one a cheap escape from the other, is deliberate; not for nothing was gin known as “mother’s ruin.” There are many other examples of Trollope’s views on the evils of drunkenness. Larry McDermot (The McDermots of Ballycloran), “an old man of fifty . . . had taken to drink . . . a slow, melancholy kind of suction, which left him never drunk, and never sober.” In Castle Richmond, Aby Mollett’s face was red and bloated, his eyes were bloodshot and protruding, his hand on a morning was unsteady, and his passion for brandy was stronger than for beefsteaks.” Captain O’Hara (An Eye for an Eye) is “horrible to look at . . . long, straggling, grizzled hair, red nose, with a drunkard’s eyes, and thin lips drawn down at the corners of the mouth.” Louis Trevelyan (He Knew He Was Right) “had taken to a little brandy in the morning, although he knew well that there was no shorter route to the devil than by such a habit.” The reason for such intemperate language is not clear: Trollope may have felt that detailing the evils of drink might dissuade readers from following a self-destructive course, or perhaps he just enjoyed letting himself go. His preaching reaches a climax in summing up Louis Scatcherd’s terminal delirium: “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 when possessed by the horrors. Nothing will cure him if not that.”

George Eliot’s output of fiction was much less than Trollope’s, but her characters have their share of the medical problems of the day. In The Sad Misfortunes of the Reverend Amos Barton, the first of the three Scenes of Clerical Life, the vicar’s wife, Milly, is pregnant for the seventh time at the age of thirty-four. She has “an illness which made her lips look pale, and rendered it absolutely necessary that she should not exert herself for some time.” She delivers a premature baby which dies four days later, dying herself soon after. The strain of many pregnancies within a few years is acknowledged, and Eliot’s disapproval of the Bartons’ irresponsibility in allowing this is hinted at. She had good reason for being critical, for she and Lewes had used contraception successfully to avoid complicating their irregular situation further. Another disastrous pregnancy occurs in Adam Bede, when Hetty Sorrel delivers her illegitimate baby in a field. The baby dies, abandoned by its mother, while Hetty, tried for murder, is sentenced to death, then reprieved and transported to Australia. She disappears from the narrative with only a brief mention of her death years after. In Middlemarch, Rosemary Lydgate miscarries after her horse has been startled while she was riding. Her husband blames her for the mishap, but she does not accept that riding was responsible and believes that she would have miscarried even if she had stayed at home. The context suggests that Lydgate believes this too, but uses the opportunity to criticise his wife. At the time of writing miscarriages were commonly attributed to accidents or shock, and for Eliot to suggest the contrary is evidence of her informed views.

Mr Gilfil’s Love-Story involves the sudden death of a young man, Captain Whybrow, whose doctor declares it to have resulted from “long-established disease of the heart, probably accelerated by some unusual emotion.”

Catrina, Mr Gilfil’s bride, fades away slowly after their marriage and dies from tuberculosis three years later. When the Reverend Mr Tryan (Janet’s Repentance) dies slowly from the same cause, the illness is only briefly recounted. His doctor “knew it was not necessary to tell (him) what was revealed by the stethoscope.” Later, “a new crisis had come on: the cough had changed its character, and the worst symptoms developed . . . the pale, wasted form . . . the thin, almost transparent hand.” These are clear hints of the advancing disease, but the illness of Mordecal (Daniel Deronda), who succumbs to consumption after many years, is not alluded to except for brief comments on his weakness, pallor and emaciation. Perhaps Eliot, like Trollope, had seen enough of this disease in her own family to avoid dwelling on its effects. A remarkable feature of Mordecai’s illness is that it does nothing to hinder his relentless verbosity.

Middlemarch, despite having a general practitioner as one of its chief characters, is free from detailed accounts of illness and death. Peter Featherstone suffers from dropsy, becomes bedridden and dies, the nature and course of his illness resembling that of Eliot’s father. Edward Casaubon consults Lydgate about his breathlessness, and the doctor uses his stethoscope which, the narrator reminds readers, “had not become a matter of course at that time” (Laennec’s paper on the stethoscope was published in 1819 and the events recounted in Middlemarch occurred twelve years later). Lydgate advises his patient to “to be satisfied with moderate work, and to seek variety of relaxation”, warning him to “straining his nervous power” and that “anxiety of any kind would be precisely the most unfavourable condition for him.” He is forbidden even to read books, advice that echoes doctors’ orders to both Eliot and Lewes when they were ill. Such restrictions would be derided today but were accepted without question in the nineetenth century. Casaubon is told that he suffers from fatty degeneration of the heart, a diagnosis in favour at that time.

Alcoholism features in Adam Bede, when Adam’s father falls into the river and drowns while making his drunken way home at night. In Janet’s Repentance Robert Dempster dies from delirium tremens. A heavy drinker, he has broken a leg in falling from his horse. Bedridden, he becomes deluded, hallucinated and terrified. “Dempster’s face was purple and swollen, his eyes dilated, and fixed with a look of terror on something which he seemed to see approaching him from the iron closet.” Marian’s father’s last illness had been complicated and his daughter’s care of him made more difficult when he also fell from a horse and broke a leg. In Middlemarch, a disreputable alcoholic, John Raffles, is told by Dr Lydgate that “the system is in a ticklish state.” An American doctor, John Ware, has recommended that the traditional use of large doses of opium and alcohol to treat alcoholism should be abandoned in favour of the total prohibition of alcohol and the use of only small doses of opium. Lydgate orders this new treatment, but his instructions are ignored, Raffles is plied with more opium, and dies. Though published in 1871, Middlemarch is set in 1831, the year in which Ware’s paper appeared, so Lydgate is shown as informed and up to date.

A further insight into Eliot’s medical knowledge occurs in Daniel Deronda; Rex Gascoigne falls from his horse and dislocates his shoulder. The dislocation is reduced by the village blacksmith, suggesting that Eliot knew that considerable physical strength was often necessary to achieve successful reduction.

In The Mill on the Floss, Edward Tulliver broods over the injustice he has suffered through the mortgage on his mill passing to an enemy. The narrator comments, “There are men whose brains have not yet been dangerously heated by the loss of a lawsuit.” Tulliver is not one of them, and collapses. Recovering consciousness, he is vague and confused until briefly restored by the sight of his beloved daughter. But “that flash of recognition had been too great a strain on the father’s bruised, enfeebled powers,” and he sinks back into insensibility. Thereafter “fits of spasmodic rigidity” alternate with apathy and passive inactivity. “With poor Tulliver, death was not to be a leap: it was to be a long descent under thickening shadows.” Finally he complains of a headache, loses consciousness and dies. It is a rare example of Eliot giving a detailed account of illness.

Later in the same year, 1859, Eliot wrote The Lifted Veil, a long short story. The father of Latimer is advised by a phrenologist that his dreamy, unpractical son needs an education that includes science; electricity, magnetism and the operation of machinery are specified. Convalescing after an illness, Latimer discovers that he is clairvoyant and can see not only into the future but also into the minds of other people. Attracted by a young woman who is engaged to his brother, he marries her when his brother dies in an accident, despite knowing that the marriage will be disastrous because he can “see into her soul” and detects evil there. There is a melodramatic climax when his wife’s maid dies frrom peritonitis and a doctor transfuses the dead woman with his own blood. This restores her to life for just enough time for her to denounce Latimer’s wife, who has planned to poison him. Latimer writes his story, having predicted his own imminent death from angina. In this Gothic fantasy Eliot invokes phrenology, mesmerism and medical experimentation, all subjects which she had read about. She was fascinated by states of altered consciousness, telling Herbert Spencer that separate trains of thought could run simultaneously through her mind so that she was “troubled by double-consciousness – a current of self-criticism being an habitual accompaniment of anything she was saying or doing, and this naturally tended towards self-depreciation and self-distrust.” Thus she rationalised a habitual lack of confidence in her work.

Two years after The Lifted Veil, Silas Marner was published. Silas suffers from catalepsy, which causes sudden spells of insensibility and rigidity.The first attack occurs during a prayer meeting when “he had fallen into a mysterious rigidity and suspension of consciousness, which, lasting for an hour or more, had been mistaken for death. To have sought a medical explanation for this phenomenon would have been held by Silas himself, as well as by his ministers and fellow-members, a wilful self-exclusion from the spiritual significance that might lie within.” This inexplicable happening causes him to be regarded with awe and approached with caution, though his skilll in providing herbal medicines alleviates his isolation as his advice is sought to treat sickness. His talent for healing adds to the sense of mystery with which he is regarded by his fellow-villagers.

In 1875 GH Lewes wrote in his journal that “after dinner while dozing in my chair (I) felt a strange pressure inside the ears accompanied by an inability to move or speak. Thought paralysis or Death. But it passed away, leaving only a sense of indigestion behind.” This may have been an isolated incident, but perhaps similar occurrences had served as a model for Marner’s catalepsy. Curious bodily sensations can occur in the interval between sleeping and waking and would inevitably provoke discussion and speculation between Lewes, who was deeply involved in studying psychology and physiology, and Eliot.

Hospitals do not feature in the work of these two authors. John Scarborough, in Trollope’s Mr Scarborough’s Family, a probable cancer sufferer, is operated on in his own home. This would have been considered a prudent choice for anyone who could afford it. Hospitals, sometimes called “the gateway to death”, were dangerously unsafe places where infections flourished and surgical operations were hazardous. Daniel Thwaite (Lady Anna), after being shot, goes to a “first class surgeon” to have a bullet removed rather than to a hospital.

Psychiatric and psychological disorders are common in Trollope’s fiction. The account of Josiah Crawley’s despair in The Last Chronicle of Barset could be read today as a case study of a depressive illness. “Morose, silent and dogged . . . always at his heart a feeling that he had been ill-used . . . he would complain . . . that his God had deserted him . . . for days and days he would sit there unwashed, with his unshorn face resting on his hand, with an old dressing-gown hanging loose about him, hardly tasting food, seldom speaking, striving to pray but striving so frequently in vain . . . and then he would rise from his chair, and, with a burst of frenzy, call upon his Creator to remove him from his misery.” And further, “this father, thouigh he loved his offspring with an affection as intense as that which human nature can supply, was not gifted with the knack of making children fond of him.”

Inability to show affection to children is a recurrent theme in Trollope’s writing. Josiah Crawley is one of several men to share the same failing. Squire Dale (The Small House at Allington) loves his nieces but cannot bring himself to show it overt affection. Sir Thomas Underwood (Ralph the Heir) “had never made a close friend yet was possessed of warm affection . . . (he) would have given much to be able to be free and jocund as were other men.” Trollope adds that “(Sir Thomas) lived with that inner feeling of almost insupportable mortification which comes from the conviction of personal failure.”

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Memories of the Trollopes’ father cast a long shadow on Anthony and his siblings. “He was a man,” wrote Anthony’s elder brother, “who would fain have been loved and knew that he was not loved, but who knew neither how to manifest his desire nor how to conciliate it”, while Anthony commented, “I believe he would have given his heart’s blood for any of us.” Trollope’s descriptions of the obsessive conjugal jealousy of Louis Trevelyan (He Knew He Was Right) and of Robert Kennedy (Phineas Finn) are equally perceptive. Trevelyan realises that his belief that his wife is unfaithful is a delusion causing him to react irrationally, but he cannot dismiss it from his mind and continues on his self-destructive course. “He was ill-dressed, haggard and worn, visibly wretched . . . he was aware of the change . . . he suspected others, feeling that he himself was suspected . . . he was conscious that he was becoming disgraced and degraded.”

The anguish of Fedinand Lopez (The Prime Minister) is followed through the eyes of a railway porter, who becomes increasingly perturbed as he sees Lopez move 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.

Nineteenth century psychiatry had little to offer the mentally ill. When Mrs O’Hara (An Eye for an Eye) 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 more need be said.” A similar feeling of hopeless inevitability is inspired by depression. Sir Thomas Fitzgerald (Castle Richmond) feels “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.”

Dementia, which clouded the last years of Trollope’s mother, surfaces in Phineas Redux : Lord Brentford, “during the two years of his exile from England, passed from manhood to senility . . . a broken-down old man whose mind had been unbooted and put into moral slippers for the remainder of its existence upon earth.” His repetitive speech exhibits the sad confusion of the condition.

Most displays of grief and despair occur among young women who have been disappointed in love or are overcome by emotion for some other reason.The prize for melodrama must surely be awarded to Grace Crawley (The Last Chronicle). Reacting with shame and outrage when her father is unjustly accused of stealing a cheque, she declares that “It would kill her father, and after that it would kill her mother, and after that it would kill her.” Even the formidable Archdeacon Grantley, informed by his son that he wishes to marry Grace, exclaims, “I think it would kill me; by Heaven, I think it would be my death.” Lady George Germaine (Is He Popenjoy?), faced with the need to address a meeting, exclaims, “I should die. Indeed, I should be dead before I could utter a word.” Although most of these protestations are described with humour, Trollope may have believed quite genuinely that a broken heart could cause death. Emily Hotspur (Sir Harry Hotspur of Humblethwaite) is sent abroad to separate her from her lover, but she fades away and dies, for “she lived as one who knew that the backbone of her life was broken.”

Whether Trollope really believed that such an outcome was possible, he was certainly aware that vague intimations of illness might precede the awful spectre of consumption. Thus, when a doctor examines the lovelorn Katie Woodward (TheThree Clerks), he says to her mother, ”There is no organic disease - yet.”

Emotional disorders occur often and tears flow frequently, and at least nineteen of Trollope’s novels contain assertions of the imminent death of individuals faced with domestic upsets. Even violence is promised; Lady Lovel (Lady AnnaI), outraged by her daughter’s wish to marry beneath her and wed a tailor, declares, “You shall never marry him – never. With my own hands I will kill him first or you.” Father Marty (An Eye for an Eye) tells Fred Neville that “(Kate O’Hara and her mother) will die. The shame and sorrow you have brought on them will bring them to their graves.”

George Eliot’s heroines also resort to tears, but on the whole they are resilient and generally recover their poise after a while. Anty Lynch (The Kellys and the O’Kellys) has a serious problem. Her dissolute alcoholic brother, Barry, is angered by having to share their father’s inheritance with her instead of having it all to himself. He attacks Anty, who flees from her home to seek sanctuary with friends. She falls ill, fever and delirium ensue, and her life is in the balance. Her hair is cut off (common practice in feverish illnesses), and eventually she recovers. There are instances in which there is a tongue-in cheek aspect to the description of emotional states. In Mr Gilfil’s Love-Story, Lady Chettam gives advice to a young woman in emotional distress. “The headaches,” she declaims, “are all from weakness. You must not over-exert yourself, and you must take bitters. I used to have the same sort of headaches when I was your age, and old Dr Samson used to say to my mother, ‘Madam, what your daughter suffers from is weakness.’ He was a curious old man, was Dr Samson.“ Her advice is delivered with lofty condescension; it is a pity that old Dr Samson did not survive long enough for Eliot to describe him more fully.

Trollope and Eliot were not alone in portraying young women as given to outbursts of weeping and faintness. Charles Dickens’s heroines are notoriously lachrymose, and other contemporary authors wrote in the same vein. Women in the novels of Trollope and Eliot include many from middle-class families, a particularly vulnerable group. Poorly educated and unable to make a career for themselves, they lived lives of stupefying boredom, constrained by the rules of society to occupy a position which gave them no scope or opportunity to exploit any talent or ambition they might have nourished. Many lived in genteel poverty, striving to keep up appearances while lacking the means to do so in comfort. Even when money was not a problem, life consisted of a dull routine of needlework, sewing and music, managing staff (all but the poorest employed a maid) and ritual visits to friends. The only prospect of escape from this depressing existence was into marriage, children and a household of their own; for this to be frustrated must have seemed overwhelmingly tragic.

Given the constraints of the limited knowledge available to them and of the delicacy necessary for authors to observe in sensitive areas, Trollope and Eliot coped well in presenting illness and death to their readers. It is the more strange, therefore, that Trollope could show apparent ignorance of the physical effect of accidents on the human frame, for some individuals show barely credible fortitude after sustaining injury. Phineas Finn, shot in a duel in Ireland, travels to England alone and resumes normal activities on arrival. Kate Vavasor (Can You Forgive Her?), her arm broken, walks home in the rain, though she does faint after getting there. Sitr Thomas Underwood (Ralph the Heir) also sustains a broken arm, but this does not prevent him from continuing his election address. The most remarkable example is provided by Giles Medlicott (Harry Heathcote of Gangoil). His collarbone broken in a fight, he continues the fight, then mounts his horse and rides fourteen miles to safety. It is worth noting that although the story takes place in Australia the main characters are English; Heathcote is an aristocrat and the police sergeant investigating the incident is an Oxford graduate and the son of a clergyman. Trollope could not completely escape class distinctions. He must have been aware that the injuries he describes are quite disabling, and that to continue to behave normally, particularly in the last example, is beyond credibility even for an Englishman. The only plausible explanation for these unrealistic accounts is carelessness.

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The Fictional Doctors

Trollope was not averse to describing physical and mental suffering when it seemed to him to be relevant to do so but, with the single exception of Thomas Thorne, doctors in his novels are relegated to the role of bystanders, their function limited to visits to the sick and dying. Few play a significant part in the stories. John Bold (The Warden) is more interested in poliitics than in medicine; he dies young. James Crofts (The Small House at AllingtonI) has only one role – to marry Lily Dale’s sister. After Crofts makes his appearance, Trollope shows that he understood the difficulties faced by general practitioners. Crofts cannot afford to marry because “old Dr Gruffen, of whom few people spoke well, had made a fortune at Guestwick and still drew from the ailments of the town a comfortable and yet hardly decreasing income.” Trollope comments that “the profession of a medical man in a small provincial town is not one which gives to its owner in early life a large income. Perhaps in no career has a man to work harder for what he earns, or to do more work without earning anything . . . young doctors doing all the work and old docctors taking all the money.”

Trollope’s references to doctors are not often favourable, and when praise is given to individual practitioners it is generally lukewarm. Thus 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), his status perhaps raised by his aristocratic surname, is “an apothecary . . . quite a genteel young man, and very respectable in the medical line.” In Alice Dugdale, a short story, Trollope writes of Alice’s father, a doctor, “I do not know that he was very great as a doctor, but he was a kind-hearted, liberal man. He knew every pulse and every tongue for miles around.” In another short story, Mary Gresley, Mary’s father “Dr Gresley, as he semed to have been called without any proper claim to the title, had been a diligent man and fairly successful.” These patronising comments suggest that Trollope may have sharred the common suspicion that the expertise of doctors below the rank of physician was dubious.

Critical observations are far more common. In The Kellys and the O’Kellys, published in 1848, Dr Coligan “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 . . . excessively dirty in his person and practice . . . would wipe his hands on the patient’s sheets . . . very fond of good eating and much drinking, and would neglect the best customer that ever was sick, when tempted by the fascination of a game of loo . . . liked his daily glass, or three or four glasses, of sherry . . . ignorant of everything but his profession, and the cards on the card-table or the racecourse.” Yet Colligan is diligent; visiting Anty Lynch three times daily when she is ill, and is so enraged by her brother’s bribe of a farm if he will ensure that Anty does not recover that he knocks him down and denounces him. Dr Macnurtrie (Phineas Finn) is Laura Kennedy’s doctor, but she is unimpressed by him; “a horrid little man . . . pawing me and covering everything with snuff . . . I hate Dr Macnurtrie.” Dr Nupper (The American Senator) has a conspicuous red nose: an enthusiastic foxhunter, he stations himself at the back of the field so that he can speedily reach the scene of any lucrative falls.

Trollope observes in Popenjoy, surely from personal observation, that . . . ”there is always a doctor in the field – sent there by some benignity of Providence, – who always rides forward enough to be near to accidents, but never so far forward as to be in front of them.” Dr Fillgrave (Doctor Thorne) has the best practice in Barchester. ”Not tall . . . perhaps more inclined to corpulence than became his height . . . he had a little round abdominal protruberance, which an inch and a half added to the heels of his boots hardly enabled him to carry off as he himself would have wished. He dearly loved a five-pound fee”, to which Trollope adds innocently, “What physician is so unnatural as not to love it?” His presence at deathbeds “adds grace to the hour of departure”, and his prediction of imminent death by a slow downward movement of his hands, accompanied by the solemn pronouncement, “we are all dust”, is alone felt to be worth his fee for attendance. Contemplating the dying Septimus Harding, he says, “He has no suffering, no pain . . . Nature simply retires to rest.” A similar attempt to comfort grieving families by meaningless utterances causes Dr Powell (Cousin Henry) to say of Indefer Jones that “he was a worn-out old man . . . the candle had nearly burned out in the socket.” Metaphors of oil lamps and candles were useful at such times, the sick Duke of Omnium (Phineas Redux) being described as “a man evidently dying, the oil of whose lamp was all burned out.”

Sir Omicron Pie flits in and out of several novels. A medical baronet from London, he is called in by Dr Fillgrave when the Dean of Barchester has a stroke because “if a man can do anything, Sir Omicron will do it . . . with such a life and such a man, Sir Omicron should be summoned.” Yet he is clearly, like Fillgrave, a pompous ass, referred to ironically as “the great London physician”, and once, slightingly, as “the little doctor.” He is fond of meaningless expressions too: summoned from retirement to attend the dying Duke of Omnium, he explains that “the vital spark is on the spring.” Ludicrously, he rations the dying man to “no more than a glass and a half of champagne a day”, and bans visitors from the sickroom. Similar petty interference occurs in The Belton Estate, when Mrs Winterfield’s doctor forbids her to attend church more than twice on Sundays and not three times as she wishes.

Doubts about doctors’ social status and competence are a frequent cause for concern. Frank Gresham (Doctor Thorne) is surprised to see a “former apothecary” among his fellow-guests at a dinner. He whispers to his neighbour, “Is he by way of a gentleman?”, to which the neighbour replies,”I suppose we must be charitable and say that he is quite as good as others that are here.” Mrs Dale (The Small House), advised by the local doctor that her maid has scarlet fever, summons Dr Crofts for his opinion, for “she had herself maintained an opposition of many years standing against the medical reputation of the apothecary.” The outspoken Miss Dunstable (Framley Parsonage), hearing that Eleanor Bold is taking her small son to the doctor, tells her, “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 considered necessary.”

Trollope’s doctors are keen to solicit the custom of the wealthy. The father of Mark Robarts (Framley Parsonage), an Exeter physician, “thought much of the breath of peers and peeresses.” Dr Pottinger (Miss Mackenzie), “was perhaps a little disappointed when he saw that she showed every sign of good health . . . he of course went among saints and sinners alike, but he found it expedient to have one tone for the saints and another for the sinners.” Even brusque Dr Thorne could collude with wealthy patients, visiting Lady Arabella Gresham “whenever it suited her turn of mind to be an invalid and have a doctor.”

But doctors had to know their place. The eccentric Lord de Guest (The Small House) dismisses his doctor because “he had laughed at him, just as if he was nobody.” They could be intimidated too. Lizzie Eustace (The Eustace Diamonds) bullies her doctor into producing a farrago of nonsense to excuse her failure to attend court. He writes, “She is far too ill to travel up to London. Pulmonary debilitation . . . depressed vitality in all the organs, and undue languor in all the bodily functions, would . . . bring her to a speedy end if she so much as thought of making a journey to London.”

Mr Martin (He Knew He Was Right) is another bullied GP, but his assailant is Sir Peter Macrudy, a physician and “the highest authority in such matters in the west of England.” Asked by Martin to see his patient, Jemima Stanbury, Sir Peter tells Jemima’s niece that “there was not a word to be said against Mr Martin . . . but he had taken one line of treatment when he ought to have taken another . . . if it pleased God, his patient would die, but it was quite possible that she might live.” Martin is demoralised and loses all confidence, and the Stanbury’s maid, witnessing his abject collapse, sniffs, “What Mr Martin says isn’t of much account.” Poor Martin is no match for Arabella French either. She takes to her bed in an attempt to win back her lover, and Martin splutters, “Her system has become low from anxiety . . . nervous, weak, liable to hysterics . . . her feelings were too much for her . . . her efforts to overcome them and face the realities of the world, had exhausted her”: to which Arabella’s sceptical sister snorts derisively, “Let her have a dose of salts.” She is not the only relative to show common sense when doctors hesitate. Katie Woodward’s griefstricken state (The Three Clerks) “puzzled that very experienced gentleman, who has the best practice in the neighbourhood of Hampton Court. He, and the London physician, agreed . . . that she would not get well . . . but that which was a mystery to the experienced medical gentlemen was no mystery to her mother.” And when the eponymous Lady Anna takes to her bed, “three doctors doubted whether she would ever get up again.” But she does, Trollope remarking dryly, “Girls do sometimes live in spite of doctors.”
   He has a sly dig at professional material-mindedness in The Belton Estate. Mr Bertram’s doctor attends his patient’s funeral and is handed a pair of black gloves by the undertaker, Mr Mortmain. He holds the gloves instead of wearing them as “otherwise Mr Mortmain could not be expected to exchange them for a pair of a lighter colour. They understood one another, and what would a country doctor do with twenty or thirty pairs of black gloves a year?”
    In the mid-1850s George Eliot wrote Amos Barton, in which Mr Pilgrim, a general practitioner, sits enjoying tea in a patient’s house. This is a favourite occupation of his, for “(he) is never so comfortable as when he is relaxing his professional legs in one of those excellent farmhouses where the mice are sleek and the mistress sickly. And at the moment he is in clover.” His hostess has a liver complaint and is well worth cultivating. They gossip; Pilgrim speaks “with his mouth only half empty of muffin”, never contradicting his patient because her “pot-luck” is always to be relied upon, and she has great trust in his “bleeding, blistering and draughts.” Before leaving the fireside he mixes himself a strong glass of “cold without” (brandy and water).
    Pilgrim returns in Janet’s Repentance, where his “large, top-booted person” enters a pub. “He had just returned from one of his long day’s rounds among the farmhouses, in the course of which he had sat down to two hearty meals which might have been mistaken for dinners if he had not declared them to be ‘snaps’, and as each snap had been followed by a few glasses of ‘mixture’, containing a less liberal portion of water than the articles he himself labelled with that broadly generic name, he was in that condition which his groom indicated with poetic ambiguity by saying that `Master had been out in the sun.`”
    There is another doctor in the town, Mr Pratt. “It is remarkable how strongly these two clever men were contrasted”: Pilgrim is tall and heavy, Pratt medium-sized and insinuating. Pratt believes debility to be the root of all ills, treating it with port wine and medicines, while Pilgrim wages war against plethora with cupping, blistering and purgatives. The two “had that sort of friendly contempt for each other which is always conducive to a good understanding between professional men.” They unite in opposing “any obnoxious and probably unqualified doctor who might presume to settle in the town.” Their patients are loyal, regarding their own doctor’s treatment as vastly superior to that of the other. There can be no question of changing their doctor, for “no one would take so serious a step as to part with the family doctor, for in those remote days there were few varieties of human hatred more formidable than the medical.” The odious Pilgrim hated Amos Barton because he had dared to call in another doctor to treat his wife.
    But inThe Mill on the Floss, published in 1860, Eliot portrays a country doctor, Mr Turnbull, very differently. His efforts to help Edward Tulliver during his illness are recognised, and he is described in affectionate terms: as “the kind old friend” and “the good angel of the house.” This is surely a reflection of the author’s gratitude to John Bury for his care of her father.
    In Silas Marner, published in 1861 but set early in the century, before the Apothecaries Act became law. Mr Kimble, the village doctor, is sometimes addressed as Dr Kimble, “for country apothecaries in old days enjoyed that title without authority of diploma”. He is a man of substance, having inherited his father’s practice and married the squire’s sister. He is noted for his irritability and is a heavy drinker. Impatient when his game of cards is interrupted by the report of a woman’s body in the snow but “drilled by the long habit of his profession into obedience to unpleasant calls, even when he was hardly sober”, he goes outside to view the body. Returning, he says dismissively, “There’s nothing to be done. She’s dead - been dead for hours, I should say . . . They must fetch her away to the workhouse tomorrow.”

Two exceptions

Trollope and Eliiot each wrote one novel iin which a general practitioner is a leading figure. Trollope wrote Doctor Thorne in 1855, Eliot published Middlemarch in 1871.  Neither the eponymous Thomas Thorne and Eliot’s Tertius Lydgate, is typical of the profession. Their characters, career and fate reveal much about their authors’ opinions of the profession of medicine.

Thorne is no ordinary general practitioner.  His father was a clergyman and a member of one of Barsetshire’s oldest families. (“He) is proud of his blood . . . none better in England . . .  (compared) to which that of the great Omnium family was but a muddy puddle”, while other doctors “have ditch-water in their veins.” He has college qualifications and could have become a physician, but chose instead to practise in Barchester until family problems caused him to move to the rural seclusion of Greshamsbury. Here his style of practice makes him unpopular, and an anti-Thorne faction forms, headed by Dr Fillgrave. Colleagues disapprove of Thorne’s methods, scorning his “low, mean, unprofessional and undemocratic” conduct in charging only seven shillings and sixpence to attend patients who live within five miles of his practice, while Fillgrave and the rest adhere to “the guinea fee.”  Thorne dispenses medicines himself, while they hold to “the principle of giving advice and selling no medicines, the great resolve to keep the distinct barrier between the physician and the apothecary.” Fillgrave’s is himself “accustomed to meet, on almost equal terms, the great medical baronets of the metropolis at the houses of the nobility.” “Almost equal” is a delightful touch.

Thorne is middle-aged, robustly self-confident and secure both in his practice and in his domestic life. He disregards criticism and ignores his enemies, treating Fillgrave, when their paths cross, with amused contempt. Ultimately he takes his rightful place alongside the leading county families and marries an heiress whose father, ironically, had made a fortune through the manufacture of a patent medicine. On hearing the news of Thorne’s impending marriage, Fillgrave sniffs, “He has been little better than a quack all his life, and now he is going to marry a quack’s daughter.” Thorne becomes a magistrate, shoots with Barsetshire’s aristocracy , and considers standing for Parliament.

Tertius Lydgate, a new arrival in Middlemarch, is twenty-seven. He is the son of an Army officer and is spoken of by a  wealthy resident of Middlemarch as “one of the Lydgates of Northumberland, really well connected.” This is not necessarily a recommendation, for Lady Chettam, discussing Lydgate’s good social connections, remarks, ”One does not expect it in a practitioner of that kind. For my part, I like a medical man on a footing with the servants, they are often all the cleverer.”

Lydgate has a vocation for medicine which his father gratifies by apprenticing him to a country physician. Qualified as a doctor, he studies further in London, Edinburgh and Paris. He decides to settle in a provincial English town where he can pursue his cherished ambitions: first, to advance scientific knowledge while simultaneously benefiting the sick; and secondly, to bring about reform of the medical profession. In order to achieve these aspirations it is necessary to live “away from the range of London intrigues (and) jealousies . . . and win celebrity, however slowly, as Jenner had done, by the independent value of his work.” The existing medical establishment, the College of Physicians . . . did not hinder quackery from having an excellent time of it.”

Though idealistic and intelligent, Lydgate is opinionated, intolerant, unwilling to compromise and fatally weak. He arouses jealousy and suspicion among the doctors of Middlemarch. Mr Wrench and Mr Toller are fellow-general practitioners. Wrench is “small, neat, bilious, with a well-dressed wig, a laborious practice, an irascible temper, a lymphatic wife and seven children”; Toller is quiet and fastidious. They “agree that Lydgate is a jackanapes . . . by not dispensing drugs (he) intended to cast imprecations on his equals, and to obscure the limit between his own rank as a general practitioner and that of the physicians who, in the interests of the profession, felt bound to maintain its various grades . . . especially 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, where observation might be abundant indeed, but hardly sound.”

Lydgate’s relations with Middlemarch’s two physicians are little better. He meets Dr Minchin and Dr Sprague in the company of the local coroner, a lawyer named Chichely. The two doctors “ concealed with much etiquette their contempt for each other’s skill”, but unite in opposing any interference, regarding Lydgate as “a layman who pried into the professional conduct of medical men .  . . offensive to the public nostril.” Minchin adds that “it is indecent in a general practitioner to contradict a physician’s diagnosis . . . Lydgate was disagreably inattentive to etiquette.”

Lydgate tells Chichely that all a coroner needs is the evidence of a medical witness, who is “often as ignorant as the coroner himself.” Chichely demurs, adding “I hope you are not one of The Lancet’’s men, wanting to take the coronership out of the hands of the legal profession” (Thomas Wakley had foundedThe Lancet, the first medical journal  published in Britain, in 1823, only eight years before the events recounted in Middlemarch,; in it he advocated the appointment of coroners with a medical rather than a legal background). “I disapprove of Wakley,” weighs in Sprague. ”He is an ill-intentioned fellow who would sacrifice the respectability of the profession, which as everyone knows depends on the London colleges, for the sake of getting some notoriety for himself.” 

Lydgate has to contend not only with the opposition of colleagues but also with an increasingly unhappy marriage to a spoiled and extravagant wife. Her spendthrift habits cause mounting financial problems, while she offers him little sympathy in his professional struggles and speaks of his occupation slightingly, saying, “I do not think it is a nice profession.” Lydgate becomes embroiled in local politics and forms an uneasy alliiance with a banker of doubtful probity. In despair he resorts to playing billiards for money and to taking opium, a habit he had scorned in others. Faced with the failure of his ambitions, he leaves Middlemarch and moves to London, dividing his time between a prosperous practice there and a continental resort. He and his wife have four daughters, but no son to whom he might have passed on his aspirations for the future of his profession. He has become just one more fashionable doctor. Gone are his plans for  brilliant research, and his sole publication is a treatise on gout. Even this is an uncomfortable reminder of Dr Sprague, whose only published work, on meningitis, was written thirty years before and one copy of which, marked “self”, was bound in calf.    Although outwardly successful, Lydgate knows himself to be a failure. He dies at the age of fifty from diphtheria. Rosemary marries again; her second husband is a wealthy elderly physician.

Conclusions

Trollope had little fondness for or confidence in doctors. By  the time he began to write he must already have acquired strong opinions about them, for there is a thundering denunciation of Dr Coligan in only his second novel. Over the next thirty-five years his fictional doctors are condemned for their unhygienic personal habits, excessive fondness for drink, greed, hypocrisy, snobbery, jealousy, bigotry, sanctimoniousness, pomposity, arrogance, sycophancy, narrow-mindedness, self-importance, spinelessness and ignorance. Negligence and malpractice were omitted from this list of shortcomings, perhaps because they were less well publicised at that time than they are today.

He may have been exasperated by doctors, but he did understand the hardships many general practitioners had to endure, and he respected genuine efforts they made to help their patients. Even the horrific description of Dr Coligan is to an extent offset by his care for the sick. The character of Thomas Thorne suggests that Trollope admired robust, honest, hard-working and plain-speaking doctors, perhaps the sort of bluff, no-nonsense practitioner, warm-hearted, kind and caring if somewhat brusque, that he might have become himself had he followed that course in life – not that that was ever likely.

George Eliot was also acquainted with doctors from childhood. She discussed both orthodox and alternative medicine with a wide circle of friends, among whom were some of the most eminent physicians of the day. Throughout her life she was grateful to doctors whom she trusted and on whom she relied to treat herself and her close relatives. 

However, she had no illusions about the profession as a whole,  and some of her  fictional doctors come in for some heavy criticism. Often depicted in contrasting pairs – Pilrgim and Platt, Toller and Wrench, Minchin and Sprague – they employ different but generally equally ineffective treatments. Family doctors are shown as lacking social graces, relying on traditional treatment and rejectng new ideas. Jealous, suspicious, unscrupulous and disputatious in their dealings with colleagues, they unite only when threatened by changes which might interfere with their traditional style of practice and, in Middlemarch,  they conspire to drive out Lydgate, whose progressive ideas constitute a threat to their comfortable lifestyle.

George Eliot knew Trollope well and read his novels as they were published. Perhaps in Middlemarch she may have followed his lead in giving prominence to a general practitioner, but one whose personality is very different from Dr Thorne. Tertius Lydgate is a more rounded, more credible figure than Thorne, who has no acknowledged faults. Lydgate’s failings arise from a fatal combination of arrogance and weakness which combine to frustrate his vision of conducting brilliant research and earning himself a place in medical history alongside his hero, Jenner. He is a tragic figure, and his abandonment of ideals and surrender to material prosperity is shown as a lost opportunity. Had she had the chance, Eliot might have chosen a scientific career rather than a literary one, and if she had become a doctor she might have shared Lydgate’s aspirations, perhaps with more ultimate success. She did not have such a choice, and this dictated her destiny as a writer. If it was a loss to medicine, it has been a gain to  readers ever since.