27 Middlemarch by George Eliot
Sometimes a doctor is the bearer of good news, when he brings a therapy or a favorable prognosis to a family in distress. But what is a doctor to say or do when such reassurance is not warranted? How is he to speak to the sick individual and his family?
In this passage from George Eliot’s Middlemarch, Dr. Lydgate is called upon to inform a household struck by disease that it must adapt itself to a new way of living an an uncertain outcome. Does he rise to the task?
The young and blooming Dorothea Brooke has made a strange marriage, baffling to those who love her: She has given herself to an aging, bloodless man, a researcher of the antiquities who is regarded by most as “scholarly and uninspired, ambitious and timid, scrupulous and dimsighted.” Though his research bears no visible fruit, Dorothea’s husband, Casaubon, cares for little else; though neither is happy, Dorothea is determined to be a good wife.
In the passage that follows, Dorothea and Casaubon quarrel, shortly after Casaubon suffers a heart attack. Dorothea is overwhelmed by fear for her husband’s health, and by remorse for the argument that preceded the attack.
The physician, Dr. Lydgate, is called. He examines his patient, both by using a then-novel instrument (his stethoscope) and by quiet observation. He calls for a cure more painful to Casaubon than any other. Casaubon must work less.
Lydgate then speaks to Dorothea, both to tell her of the grim outlook he sees for her husband, and also to indulge his curiosity about her and her marriage.
Before speaking to Dorothea, Lydgate resolves to avoid a “momentous prophecy” that might be disproven by events, despite his interest in seeing how such a prediction might affect her. Instead, he simply advises her to to “be very watchful” over her husband’s exertions. Dorothea, however, ever perceptive, hears what Lydgate does not say and begs him to tell her the worst, so that she might be spared future regret over preventive measures she did not take. He agrees that forestalling such regret is “one’s function as a medical man,” and tells her bluntly what the worst outcome might be. He also tells her, though, that he plans not to “enlighten” Casaubon, fearing that anxiety would be unhealthy for the patient. – Leon Kass
Excerpt:
Dorothea had learned to read the signs of her husband’s mood, and she saw that the morning had become more foggy there during the last hour. She was going silently to her desk when he said, in that distant tone which implied that he was discharging a disagreeable duty—
“Dorothea, here is a letter for you, which was enclosed in one addressed to me.”
It was a letter of two pages, and she immediately looked at the signature.
“Mr. Ladislaw! What can he have to say to me?” she exclaimed, in a tone of pleased surprise. “But,” she added, looking at Mr. Casaubon, “I can imagine what he has written to you about.”
“You can, if you please, read the letter,” said Mr. Casaubon, severely pointing to it with his pen, and not looking at her. “But I may as well say beforehand, that I must decline the proposal it contains to pay a visit here. I trust I may be excused for desiring an interval of complete freedom from such distractions as have been hitherto inevitable, and especially from guests whose desultory vivacity makes their presence a fatigue.”
There had been no clashing of temper between Dorothea and her husband since that little explosion in Rome, which had left such strong traces in her mind that it had been easier ever since to quell emotion than to incur the consequence of venting it. But this ill-tempered anticipation that she could desire visits which might be disagreeable to her husband, this gratuitous defence of himself against selfish complaint on her part, was too sharp a sting to be meditated on until after it had been resented. Dorothea had thought that she could have been patient with John Milton, but she had never imagined him behaving in this way; and for a moment Mr. Casaubon seemed to be stupidly undiscerning and odiously unjust. Pity, that “new-born babe” which was by-and-by to rule many a storm within her, did not “stride the blast” on this occasion. With her first words, uttered in a tone that shook him, she startled Mr. Casaubon into looking at her, and meeting the flash of her eyes.
“Why do you attribute to me a wish for anything that would annoy you? You speak to me as if I were something you had to contend against. Wait at least till I appear to consult my own pleasure apart from yours.”
“Dorothea, you are hasty,” answered Mr. Casaubon, nervously.
Decidedly, this woman was too young to be on the formidable level of wifehood—unless she had been pale and featureless and taken everything for granted.
“I think it was you who were first hasty in your false suppositions about my feeling,” said Dorothea, in the same tone. The fire was not dissipated yet, and she thought it was ignoble in her husband not to apologize to her.
“We will, if you please, say no more on this subject, Dorothea. I have neither leisure nor energy for this kind of debate.”
Here Mr. Casaubon dipped his pen and made as if he would return to his writing, though his hand trembled so much that the words seemed to be written in an unknown character. There are answers which, in turning away wrath, only send it to the other end of the room, and to have a discussion coolly waived when you feel that justice is all on your own side is even more exasperating in marriage than in philosophy.
Dorothea left Ladislaw’s two letters unread on her husband’s writing-table and went to her own place, the scorn and indignation within her rejecting the reading of these letters, just as we hurl away any trash towards which we seem to have been suspected of mean cupidity. She did not in the least divine the subtle sources of her husband’s bad temper about these letters: she only knew that they had caused him to offend her. She began to work at once, and her hand did not tremble; on the contrary, in writing out the quotations which had been given to her the day before, she felt that she was forming her letters beautifully, and it seemed to her that she saw the construction of the Latin she was copying, and which she was beginning to understand, more clearly than usual. In her indignation there was a sense of superiority, but it went out for the present in firmness of stroke, and did not compress itself into an inward articulate voice pronouncing the once “affable archangel” a poor creature.
There had been this apparent quiet for half an hour, and Dorothea had not looked away from her own table, when she heard the loud bang of a book on the floor, and turning quickly saw Mr. Casaubon on the library steps clinging forward as if he were in some bodily distress. She started up and bounded towards him in an instant: he was evidently in great straits for breath. Jumping on a stool she got close to his elbow and said with her whole soul melted into tender alarm—
“Can you lean on me, dear?”
He was still for two or three minutes, which seemed endless to her, unable to speak or move, gasping for breath. When at last he descended the three steps and fell backward in the large chair which Dorothea had drawn close to the foot of the ladder, he no longer gasped but seemed helpless and about to faint. Dorothea rang the bell violently, and presently Mr. Casaubon was helped to the couch: he did not faint, and was gradually reviving, when Sir James Chettam came in, having been met in the hall with the news that Mr. Casaubon had “had a fit in the library.”
“Good God! this is just what might have been expected,” was his immediate thought. If his prophetic soul had been urged to particularize, it seemed to him that “fits” would have been the definite expression alighted upon. He asked his informant, the butler, whether the doctor had been sent for. The butler never knew his master to want the doctor before; but would it not be right to send for a physician?
When Sir James entered the library, however, Mr. Casaubon could make some signs of his usual politeness, and Dorothea, who in the reaction from her first terror had been kneeling and sobbing by his side now rose and herself proposed that some one should ride off for a medical man.
“I recommend you to send for Lydgate,” said Sir James. “My mother has called him in, and she has found him uncommonly clever. She has had a poor opinion of the physicians since my father’s death.”
Dorothea appealed to her husband, and he made a silent sign of approval. So Mr. Lydgate was sent for and he came wonderfully soon, for the messenger, who was Sir James Chettam’s man and knew Mr. Lydgate, met him leading his horse along the Lowick road and giving his arm to Miss Vincy.
Celia, in the drawing-room, had known nothing of the trouble till Sir James told her of it. After Dorothea’s account, he no longer considered the illness a fit, but still something “of that nature.”
“Poor dear Dodo—how dreadful!” said Celia, feeling as much grieved as her own perfect happiness would allow. Her little hands were clasped, and enclosed by Sir James’s as a bud is enfolded by a liberal calyx. “It is very shocking that Mr. Casaubon should be ill; but I never did like him. And I think he is not half fond enough of Dorothea; and he ought to be, for I am sure no one else would have had him—do you think they would?”
“I always thought it a horrible sacrifice of your sister,” said Sir James.
“Yes. But poor Dodo never did do what other people do, and I think she never will.”
“She is a noble creature,” said the loyal-hearted Sir James. He had just had a fresh impression of this kind, as he had seen Dorothea stretching her tender arm under her husband’s neck and looking at him with unspeakable sorrow. He did not know how much penitence there was in the sorrow.
“Yes,” said Celia, thinking it was very well for Sir James to say so, but he would not have been comfortable with Dodo. “Shall I go to her? Could I help her, do you think?”
“I think it would be well for you just to go and see her before Lydgate comes,” said Sir James, magnanimously. “Only don’t stay long.”
While Celia was gone he walked up and down remembering what he had originally felt about Dorothea’s engagement, and feeling a revival of his disgust at Mr. Brooke’s indifference. If Cadwallader—if every one else had regarded the affair as he, Sir James, had done, the marriage might have been hindered. It was wicked to let a young girl blindly decide her fate in that way, without any effort to save her. Sir James had long ceased to have any regrets on his own account: his heart was satisfied with his engagement to Celia. But he had a chivalrous nature (was not the disinterested service of woman among the ideal glories of old chivalry?): his disregarded love had not turned to bitterness; its death had made sweet odors—floating memories that clung with a consecrating effect to Dorothea. He could remain her brotherly friend, interpreting her actions with generous trustfulness.
Mr. Casaubon had no second attack of equal severity with the first, and in a few days began to recover his usual condition. But Lydgate seemed to think the case worth a great deal of attention. He not only used his stethoscope (which had not become a matter of course in practice at that time), but sat quietly by his patient and watched him. To Mr. Casaubon’s questions about himself, he replied that the source of the illness was the common error of intellectual men—a too eager and monotonous application: the remedy was, to be satisfied with moderate work, and to seek variety of relaxation. Mr. Brooke, who sat by on one occasion, suggested that Mr. Casaubon should go fishing, as Cadwallader did, and have a turning-room, make toys, table-legs, and that kind of thing.
“In short, you recommend me to anticipate the arrival of my second childhood,” said poor Mr. Casaubon, with some bitterness. “These things,” he added, looking at Lydgate, “would be to me such relaxation as tow-picking is to prisoners in a house of correction.”
“I confess,” said Lydgate, smiling, “amusement is rather an unsatisfactory prescription. It is something like telling people to keep up their spirits. Perhaps I had better say, that you must submit to be mildly bored rather than to go on working.”
“Yes, yes,” said Mr. Brooke. “Get Dorothea to play backgammon with you in the evenings. And shuttlecock, now—I don’t know a finer game than shuttlecock for the daytime. I remember it all the fashion. To be sure, your eyes might not stand that, Casaubon. But you must unbend, you know. Why, you might take to some light study: conchology, now: I always think that must be a light study. Or get Dorothea to read you light things, Smollett—‘Roderick Random,’ ‘Humphrey Clinker:’ they are a little broad, but she may read anything now she’s married, you know. I remember they made me laugh uncommonly—there’s a droll bit about a postilion’s breeches. We have no such humor now. I have gone through all these things, but they might be rather new to you.”
“As new as eating thistles,” would have been an answer to represent Mr. Casaubon’s feelings. But he only bowed resignedly, with due respect to his wife’s uncle, and observed that doubtless the works he mentioned had “served as a resource to a certain order of minds.”
“You see,” said the able magistrate to Lydgate, when they were outside the door, “Casaubon has been a little narrow: it leaves him rather at a loss when you forbid him his particular work, which I believe is something very deep indeed—in the line of research, you know. I would never give way to that; I was always versatile. But a clergyman is tied a little tight. If they would make him a bishop, now!—he did a very good pamphlet for Peel. He would have more movement then, more show; he might get a little flesh. But I recommend you to talk to Mrs. Casaubon. She is clever enough for anything, is my niece. Tell her, her husband wants liveliness, diversion: put her on amusing tactics.”
Without Mr. Brooke’s advice, Lydgate had determined on speaking to Dorothea. She had not been present while her uncle was throwing out his pleasant suggestions as to the mode in which life at Lowick might be enlivened, but she was usually by her husband’s side, and the unaffected signs of intense anxiety in her face and voice about whatever touched his mind or health, made a drama which Lydgate was inclined to watch. He said to himself that he was only doing right in telling her the truth about her husband’s probable future, but he certainly thought also that it would be interesting to talk confidentially with her. A medical man likes to make psychological observations, and sometimes in the pursuit of such studies is too easily tempted into momentous prophecy which life and death easily set at nought. Lydgate had often been satirical on this gratuitous prediction, and he meant now to be guarded.
He asked for Mrs. Casaubon, but being told that she was out walking, he was going away, when Dorothea and Celia appeared, both glowing from their struggle with the March wind. When Lydgate begged to speak with her alone, Dorothea opened the library door which happened to be the nearest, thinking of nothing at the moment but what he might have to say about Mr. Casaubon. It was the first time she had entered this room since her husband had been taken ill, and the servant had chosen not to open the shutters. But there was light enough to read by from the narrow upper panes of the windows.
“You will not mind this sombre light,” said Dorothea, standing in the middle of the room. “Since you forbade books, the library has been out of the question. But Mr. Casaubon will soon be here again, I hope. Is he not making progress?”
“Yes, much more rapid progress than I at first expected. Indeed, he is already nearly in his usual state of health.”
“You do not fear that the illness will return?” said Dorothea, whose quick ear had detected some significance in Lydgate’s tone.
“Such cases are peculiarly difficult to pronounce upon,” said Lydgate. “The only point on which I can be confident is that it will be desirable to be very watchful on Mr. Casaubon’s account, lest he should in any way strain his nervous power.”
“I beseech you to speak quite plainly,” said Dorothea, in an imploring tone. “I cannot bear to think that there might be something which I did not know, and which, if I had known it, would have made me act differently.” The words came out like a cry: it was evident that they were the voice of some mental experience which lay not very far off.
“Sit down,” she added, placing herself on the nearest chair, and throwing off her bonnet and gloves, with an instinctive discarding of formality where a great question of destiny was concerned.
“What you say now justifies my own view,” said Lydgate. “I think it is one’s function as a medical man to hinder regrets of that sort as far as possible. But I beg you to observe that Mr. Casaubon’s case is precisely of the kind in which the issue is most difficult to pronounce upon. He may possibly live for fifteen years or more, without much worse health than he has had hitherto.”
Dorothea had turned very pale, and when Lydgate paused she said in a low voice, “You mean if we are very careful.”
“Yes—careful against mental agitation of all kinds, and against excessive application.”
“He would be miserable, if he had to give up his work,” said Dorothea, with a quick prevision of that wretchedness.
“I am aware of that. The only course is to try by all means, direct and indirect, to moderate and vary his occupations. With a happy concurrence of circumstances, there is, as I said, no immediate danger from that affection of the heart, which I believe to have been the cause of his late attack. On the other hand, it is possible that the disease may develop itself more rapidly: it is one of those cases in which death is sometimes sudden. Nothing should be neglected which might be affected by such an issue.”
There was silence for a few moments, while Dorothea sat as if she had been turned to marble, though the life within her was so intense that her mind had never before swept in brief time over an equal range of scenes and motives.
“Help me, pray,” she said, at last, in the same low voice as before. “Tell me what I can do.”
“What do you think of foreign travel? You have been lately in Rome, I think.”
The memories which made this resource utterly hopeless were a new current that shook Dorothea out of her pallid immobility.
“Oh, that would not do—that would be worse than anything,” she said with a more childlike despondency, while the tears rolled down. “Nothing will be of any use that he does not enjoy.”
“I wish that I could have spared you this pain,” said Lydgate, deeply touched, yet wondering about her marriage. Women just like Dorothea had not entered into his traditions.
“It was right of you to tell me. I thank you for telling me the truth.”
“I wish you to understand that I shall not say anything to enlighten Mr. Casaubon himself. I think it desirable for him to know nothing more than that he must not overwork himself, and must observe certain rules. Anxiety of any kind would be precisely the most unfavorable condition for him.”
Lydgate rose, and Dorothea mechanically rose at the same time, unclasping her cloak and throwing it off as if it stifled her. He was bowing and quitting her, when an impulse which if she had been alone would have turned into a prayer, made her say with a sob in her voice—
“Oh, you are a wise man, are you not? You know all about life and death. Advise me. Think what I can do. He has been laboring all his life and looking forward. He minds about nothing else.— And I mind about nothing else—”
For years after Lydgate remembered the impression produced in him by this involuntary appeal—this cry from soul to soul, without other consciousness than their moving with kindred natures in the same embroiled medium, the same troublous fitfully illuminated life. But what could he say now except that he should see Mr. Casaubon again to-morrow?
Visit George Eliot on The British Library’s website
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If you are interested, there is a 1994 Masterpiece Theatre production of Middlemarch, adapted from the George Eliot classic, set at the cusp of the Industrial Revolution, chronicles the life, loves, foibles, and politics of the fictional English town of Middlemarch. The 7-episode series can be seen on Amazon Prime.
Consider this:
- Does Lydgate’s strategy do justice to either Dorothea or Casaubon? Should he have acted differently?
- As Lydgate is leaving, Dorothea appeals to him in an outburst, “from soul to soul.” Eliot tells us that “for years after Lydgate remembered the impression produced in him by this involuntary appeal. But what should he say now except that he should see Mr. Casaubon again tomorrow? What, indeed, should he have said? Should he — could he — have said or done anything more comforting?