Middlemarch by George Eliot Prof Vinod Patel

George Eliot’s Middlemarch
So far
Vinod Patel
Warwick Medical School
Hon Consultant in Endocrinology and Diabetes
George Eliot Hospital NHS Trust
Several images from the
Welcome History of Medicine
Image Bank

Middlemarch
by
George Eliot
Middlemarch, a microcosm tracing
the tensions between society's
expectations and individual desire in
the interlocking characters of a
provincial village

Ahead of:
Grapes of wrath
100 years of solitude
Crime & Punishment
Bridget Jones's Diary
Lord of the flies
The Godfather
Sadly behind
Catch 22
To kill a mockingbird
1984
Captain Correlli’s Mandolin
Bored of the Rings
The Hairy Potter Books
BBC asked the British public in April 2003
14,000 votes, Top 100 shown here !

BBC asked the British public in April 2003
14,000 votes, Top 100
1. The Lord of the Rings, JRR Tolkien
2. Pride and Prejudice, Jane Austen
3. His Dark Materials, Philip Pullman
4. The Hitchhiker's Guide to the Galaxy, Douglas Adams
5. Harry Potter and the Goblet of Fire, JK Rowling
6. To Kill a Mockingbird, Harper Lee
7. Winnie the Pooh, AA Milne
8. Nineteen Eighty-Four, George Orwell
9. The Lion, the Witch and the Wardrobe, CS Lewis
10. Jane Eyre, Charlotte Brontë
11. Catch-22, Joseph Heller
12. Wuthering Heights, Emily Brontë
13. Birdsong, Sebastian Faulks
14. Rebecca, Daphne du Maurier
15. The Catcher in the Rye, JD Salinger
16. The Wind in the Willows, Kenneth Grahame
17. Great Expectations, Charles Dickens
18. Little Women, Louisa May Alcott
19. Captain Corelli's Mandolin, Louis de Bernieres
20. War and Peace, Leo Tolstoy
21. Gone with the Wind, Margaret Mitchell
22. Harry Potter And The Philosopher's Stone, JK Rowling
23. Harry Potter And The Chamber Of Secrets, JK Rowling
24. Harry Potter And The Prisoner Of Azkaban, JK Rowling
25. The Hobbit, JRR Tolkien
26. Tess Of The D'Urbervilles, Thomas Hardy
27. Middlemarch, George Eliot
28. A Prayer For Owen Meany, John Irving
29. The Grapes Of Wrath, John Steinbeck
30. Alice's Adventures In Wonderland, Lewis Carroll

Vinod Patel Analysis:
minus children’s book
1. Pride and Prejudice, Jane Austen
2. To Kill a Mockingbird, Harper Lee
3. Nineteen Eighty-Four, George Orwell
4. Jane Eyre, Charlotte Brontë
5. Catch-22, Joseph Heller
6. Wuthering Heights, Emily Brontë
7. Birdsong, Sebastian Faulks
8. Rebecca, Daphne du Maurier
9. The Catcher in the Rye, JD Salinger
10. Great Expectations, Charles Dickens
11. Captain Corelli's Mandolin, Louis de Bernieres
12. War and Peace, Leo Tolstoy
13. Gone with the Wind, Margaret Mitchell
14. Tess Of The D'Urbervilles, Thomas Hardy
15.Middlemarch, George Eliot
16. A Prayer For Owen Meany, John Irving
17. The Grapes Of Wrath, John Steinbeck
Virginia Wolff: unstinting praise,
describing Middlemarch as "the
magnificent book that, with all its
imperfections, is one of the few
English novels written for grown-up
people.“
Martin Amiss and Julian Barnes:
have cited it as probably the
greatest novel in the English
language.[

Head of communication and marketing –
Nigel Lucas
“had nightmares about
Middlemarch…it was
horrendous!
…I was forced to read it

Historical backdrop
• Novel set 1829 to 1832, time of
British Empire extension and
consolidation
• Major changes in English society,
science foothold in thinking
• Increasing industrialisation: railways
• Property rights of landowners
extended, common land reduced
• Often poverty in rural areas, violent
protests, burning of crops and
hanging for sheep theft
• Major move to the industry in towns
Welcome

Historical backdrop 2
• 1832 Reform Act by PM Lord Grey, promoted
middle classes to vote, Ten Pound Act
• working class men in towns had to wait until
Disraeli’s Second reform Act 1867, and
Agricultural Workers until 1867
• Women until 20th Century! 1918 if 30 OK for men
at 21
• Equality of worship by Roman Catholic Relief Act
1829 by Robert Peel and Duke of Wellington
• Theory of Evolution by Darwin resulted in an
English “wave of skepticism” about religion and
accepted order in society

Historical backdrop 3
• The beginnings of feminism
• Elizabeth Garrett first female British
doctor 1860’s
• Key work had been Mary
Wollstonecraft’s “Vindication of the
Rights of Woman” 1792
• Evolutionary theory led to views that
the gradual evolution and change in
society is served by personal vision
and ….small but distinct reforms
• The French Dissent was sounding a
warning to British Government that
reform could avoid more overt and
military dissent
Welcome

George Eliot
A woman in advance of her time
• Born Mary Ann Evans,1819 in a farmhouse Arbury Hall.
Father Robert Evans was agent to the Newdegate family
• Mary Ann was 4 months old,moved to Griff House
• Mary Ann,sister Chrissey,Isaac. Boarding school in
Nuneaton, until Mary Ann was moved, at the age of 13, to
boarding school in Coventry at 29 Warwick Row
• Age 16, her mother died, Robert Evans relied upon his
youngest daughter in running of the household
• Mary Ann had been a bright scholar, lessons from teachers
from Griff from Coventry and Leamington.

George Eliot
• Robert Evans retired to Coventry in 1841, taking Mary
Ann with him and leaving Isaac at Griff to take over
Arbury Estate.
• Mary Ann at Foleshill and a stimulating intellectual circle
flourished.
• Writing articles for Bray's Coventry Herald newspaper
• Previously devout Mary Ann had already had religious
doubts and soon she realised her faith had gone
• Refused to attend Holy Trinity Church with her father,
causing great distress. Only went back to church having
reserved the right to think her own thoughts during the
service!

George Eliot
• Into her 20s with no marriage in sight. She was almost
engaged to an artist at Baginton
• Robert Evans died in 1849, now calling herself Marian,
moved to London
• Here she had a relationship with the publisher John
Chapman and almost married with the philosopher
Herbert Spencer.
• Early 1850's, when she was in her thirties, met George
Henry Lewes

George Eliot
• In 1854, defying the rules of Victorian
society, they began to live together as
man and wife
• This liaison, a true marriage even if not a
legal one, shocked family and friends.
• Ostracised by the people who had
previously been happy to dine her
• When her family in Nuneaton knew about
her relationship with Lewes, they
disowned her, effectively exiling her from
her beloved Warwickshire which is where
she felt her true roots were.
Welcome

George Eliot
• Began to write fiction, and became the successful author of 8
novels, all of them hugely popular with the exception of
Romola
• She became one of the highest paid Victorian novelists and
was idolised.
• She chose her pen-name George Eliot to hide her irregular
union with a married man, and her fame & acceptance in the
world which had earlier condemned her.
• She and Lewes had no children but she cared deeply for
Lewes's three sons who returned her love.
• Her life with Lewes, ideally happy, ended in 1878, he died

George Eliot
• After Lewes's death she married John Walter Cross, 20 years
her junior in 1880
• Only then did her brother Isaac and the Evans family accept
her once again.
• Unfortunately, never able to visit them because she died
seven and a half months after her marriage.
• She is buried in London's Highgate Cemetery, having earlier
been rejected by Westminster Abbey
• Many felt she should have rested amongst the
other great names in our literary heritage.
• 100 years after her death a memorial
stone was erected to her in Poets' Corner in the
Abbey

George Eliot's list of work
• Scenes of Clerical Life (1857)
• Adam Bede (1859)
• The Lifted Veil (1859)
• The Mill on the Floss (1860)
• Silas Marner: the Weaver of Raveloe (1861)
• Romola (published in parts from 1862-3)
• Brother Jacob (1864)
• Felix Holt, The Radical (1866)
• The Spanish Gypsy (1868)
• Middlemarch (published in parts from 1871-2)
Dorothea, Lydgate, Mary Garth,
• Daniel Deronda (published in parts from 1874-1876)

Middlemarch: The Novel
• Middlemarch is arguably one of the masterpieces of
English fiction.
• Printed in instalments between 1871 and 1872, it
received tremendous acclaim from the reading public
• It is retrospectively set in the years between 1829 and
1832, an era of major political and social reform.
• Originally conceived as two distinct stories, one
concerning the marriage of Dorothea Brooke and the
other based on the ambitious Dr Tertius Lydgate
• Eliot, always a keen investigator and social
commentator, did extensive research on current and
historical developments in medicine.

Middlemarch: The Novel
• Lydgate allows George Eliot to reveal the snobbish
and professional tensions gathering pace during that
era. Lydgate had completed his medical studies in the
forward-looking medical schools of London, Edinburgh
and Paris and not at Oxford or Cambridge, the
customary seats of gentlemanly learning.
• Eliot explores nearly every subject of concern to
modern life: art, religion, science, politics, self, society,
human relationships.

Middlemarch; A synopsis
Dorothea Brooke
Joshua Rigg
Cadwalladers
Raffles
Farebrother
Casaubon
Subsiduary stories
Mary Garth
Fred Vincy
Will Ladislaw, Bulstrode
Dr Lydgate
Middlemarch
A Study of Provincial Life

Middlemarch; A
synopsis
Your Character from literature and
idea in relation to medical
humanities
Welcome

Middlemarch; A
synopsis Dorothea Brookes
• “A young woman of unusual beauty”
• Idealist, wealthy, altruistic philanthropist
marries an older academic scholar
(Casaubon), whose research is going
nowhere (the Key to Mythologies)
• Had started infant school in village, plans
for cottages for laborers
• Ends up being subordinated to
Casaubon’s work, realises folly
• Luckily, Casaubon dies
Welcome

Middlemarch; A
• Casaubon’s Will states that to marry Will
Ladislaw (his cousin) would result in loss
of inheritance for Dorothea
• Eventually marries the radical and
soulmate Will Ladislaw who becomes a
reforming MP
• Becomes wife mother but engaged in
“beneficient activity”
• Feels fulfilled helping a reformimg MP but
other others do not see her aspirations
fulfilled
Welcome

Middlemarch; A
synopsis Dr Tertius Lydgate
Welcome

Middlemarch; A
• Has “ heavy eyebrows, dark eyes, a
straight nose, thick dark hair, large solid
white hands” voice “deep and sonorous”
• Medicine in London, Edinburgh and Paris
arrives in Middlemarch age 27, to
supervise the new hospital
• Mr. Lydgate had the medical
accomplishment of looking perfectly grave
whatever nonsense was talked to him, and
his dark steady eyes gave him
impressiveness as a listener.
• Introduces new practices, even the
stethoscope, uses microscope.
Welcome

Middlemarch; A
• “Intellectual passion” discloses an affinity
for Dorothea but marries the pretty and
wifely Rosamond Vincy
• He is presented as intellectually zealous
and teeming with a naive enthusiasm for
the value of scientific advancement for
society’s benefit.
• Research: Search for Primitive tissue
from which all others derive
• These progressive ideas do not find
favour with the more entrenched views of
his Middlemarch colleagues
Welcome

Middlemarch; A
• His marriage to Rosamond is as
“debilitating” as Dorothea’s to Casaubon
in term of allowing self development
• His mode of practice destines him to a
poor income and bankruptcy looms
• Raffles, blackmailing a local banker (Mr
Bulstrode), is treated for Alcoholic
poisoning, Lydgate’s instruction not to
give alcohol and opium together are
ignored and Raffles dies
• Mr Bulstrode clears Lydgate’s debts of
£1000 pounds.
Welcome

Middlemarch; A
• Public suspicions aroused re foul play
• Dorothea offers sincere and financial help,
but this did not serve longer term problem
with marriage
• Moves to London and a Continental
bathing place “gained an excellent practice”
“having written a treatise on gout” “which
has a good deal of wealth on its side”
• ”but he always regarded himself as a
failure: he had not done what he once
meant to do.”
• “he died prematurely of diptheria” his hair “
never become white”
Welcome: PS Eiffel Tower 1889!

• Re: model housing and the proposed
fever hospital.
• "Worth doing! yes, indeed," said
Dorothea, energetically, forgetting her
previous small vexations. "I think we
deserve to be beaten out of our
beautiful houses with a scourge of small
cords--all of us who let tenants live in
such pigsties as we see round us. Life
in cottages might be happier…if they
were real houses fit for human beings
from whom we expect duties and
affections.“
• The beginning of what she calls ‘ the
stealthy convergence of human lots’
Inequalities and Housing
Inequalities and housing
Welcome

"I don't pretend to argue with a lady on politics," said
Mr. Brooke, with an air of smiling indifference…."Your
sex are not thinkers, you know--varium et mutabile
semper--that kind of thing…“
“And there is no part of the county where opinion is
narrower than it is here…”
* Fickle and ever changing!
The quote applies to NHS management!
Not to women! Honestly
Is opinion narrow in Nuneaton?
The Non-PC Mr. Brookes!

"Hire facounde eke full
womanly and plain, No
contrefeted termes had she to
semen wise."
--CHAUCER.
? What the Hell!
Please help with this one!
Welcome

Middlemarch SSC Timetable
Week Date Topic
1 Background to the SSC
Background to The Special Study Module in Medical Humanities
The students will be advised to read any edition with an introduction
ideally. Most have good essay on the background to George Eliot and her
works and Victorian England and its place in the world. The students
would have been expected to read 25% of the book within the first week!
In this session students will discuss their views on how the reading of the
book so far could have any relationship to helping them become better
clinical professionals in the future. This session purposefully will not cover
the definitions of medical humanities and their role as defined in the
current literature, as the main aim of this session is to have open and
unfettered discussion on the potential role of medical humanities in the
medical curriculum and conditioned professional development.

Week Date Topic
2 Introduction to Humanities
Session 2: Introduction- Tutor Bazaar.
This is where the Lead Tutor (Dr Patel) will outline the significance of
Humanities in the further development of Healthcare Professionals. This
would be particularly in relation to the definition of Medical Humanities,
Introduction to George Eliot the Author, Introduction to where Middlemarch
is in the Canons of English Literature and a background to Life and
Circumstances in Victorian England.

Week Date Topic
2 Introduction to Humanities: Tutor Bazaar
Session 2: Introduction- Tutor Bazaar.
• You will be presented with an item from the tutor based usually on
a book or art (pictorial)
Remit
• Embrace the item allocated or despair and change
• Spend 15 minutes on the item and:
• Prepare to present back on its meaning for you in relation to
medical humanities and potential for professional
development
• Be prepared to answer awkward questions from Fellow
Students and Tutor

Week Date Topic
5 22
Oct
Medical Student Bazaar
Session 5: Medical Student Bazaar
You should bring something (1 or several items) that can stimulate a
discussion around any aspects of Medical Humanities. It can be
almost anything (but must be able to present on screen or show a
small table). ? Books, Art, Poem, Play, Music, Film, Sculpture, Object
etc etc
Remit
• Brief introduction
• Lead open discussion focussing on its meaning for students
and then specific to you. This is generally in relation to
medical humanities and potential for professional
development
• Be prepared to answer awkward questions from Fellow
Students and Tutor

Middlemarch SSC: Tutor Bazaar
Week Date Introduction to Humanities: Tutor Bazaar
2 Name of Student
Item allocated/chosen
Notes to present back on its meaning for you in relation to medical humanities and potential
for professional development
Final Comments

Week Date Topic
3 Characters & themes: All
Session 3: Characters and Themes
We will explore the main characters. This will be particularly Dorothea,
Lydgate, Casaubon, Rosamund. The initial themes we would explore
would be as follows;
Public Health
Professionalism
Social Interactions
Clinical Cases in Middlemarch

Middlemarch SSM Timetable
Week Date Topic
4 Quotations: All
Session 4: Quotations
All the students will be invited to bring at least two quotations which will be
presented as a slide. The students will be expected to give a background
to the context to the quotation. All quotations will be taken from the first
half of the book only as all students will be expected to have read the first
half of the book only at this stage. The quotations will be read out by the
students and discussed by the audience and this will be presented in
order, from the beginning of the book towards the middle of the book. The
discussion will centre around reflections on professional practice, social
circumstances, historical perspectives and development of the characters
in the book.

Week Date Topic
5 BBC adaptation
Session 5: BBC Adaptation
The film is actually around 6 hours long. We will present exerts which go
from the beginning of the film to the end of the film, particularly
concentrating on the character of Lydgate, Dorothea, Kashbon, Medical
Themes and Good Governance. The students will be expected to discuss
these within our tutorial setting.

Week Date Topic
6 Review of the Role of Medical Humanities in Medical
Education and the Student Bazaar
Session 6: Review of the role of medical humanities in medical
education
The students will be expected to finish off the reading of the novel and
reach the end. This discussion will continue on from the discussion
commenced in session 1 and help students formulate how the medical
humanities could have a role in their own future professional development
and continued education. And the Medical Student Bazaar, based on a
format similar to week 2.

Week Date Topic
7 Medicine in Middlemarch
Session 7: Medicine in Middlemarch
Using a teaching format predominantly slides, developed with the
Welcome History of Medicine Museum in London, the main tutor (Dr Patel)
with present medical themes in Middlemarch. We will also ask Dr J
Morrissey, who was previously a Joint Module Leader, to participate in this
tutorial. We will explore:
Social Inequalities
Clinical Cases in Middlemarch
Lifestyle Advice
Professional Practice

Week Date Topic
8 Contemporary Resonances
Session 8: Contemporary resonances: All
This will be an open discussion around both formulating ideas for
presentations as part of the assessment and also exploring the relevance
of Middlemarch in modern day life. We will explore recently written papers
and books on the subject through our reading list and core English
literature journals.

Week Date Topic
9 & 10 Presentations & Reflections 1
Session 9: Presentations & Reflections 1
Presentations will be presented individually with time allocated for
discussion. Usually the presentations will be 10 – 15 minutes long with 5
– 10 minute discussion. At the end of this session there will be a
workshop if needed, on how to write reflections.

Middlemarch; A
Welcome

• “Lydgate has lots of ideas, quite new, about
ventilation and diet, that sort of thing,"
resumed Mr. Brooke, to… Middlemarchers.
• “Hang it, do you think that is quite sound?--
upsetting The old treatment, which has made
Englishmen what they re?" said Mr. Standish.
• “She had brought up her children….not to
over-eat themselves,…habit she considered
the chief reason why people needed doctors.
• Lydgate pleaded for those whose fathers and
mothers had over-eaten themselves…”
• "Men of your profession don't generally
smoke," he said. Lydgate smiled and shook
his head. "Nor of mine either, properly.
Life Style Advice
Lifestyle Advice
Welcome

• "Medical knowledge is at a low ebb among
us," said Mr. Bulstrode, …"I… hail the
advent of Mr. Lydgate.“
• "That is all very fine," replied Mr. Standish,...
"if you like him to try experiments on your
hospital patients, and kill a few people for
charity I have no objection…(but will not)
hand money …to have experiments tried on
me. I like treatment that has been tested a
little.“
• "Well, you know, Standish, every dose you
take is an experiment-an experiment, you
know," said Mr. Brooke.
Skepticism of Local Doctors
Welcome

“But Lydgate was young, poor, ambitious. He
had his half-century before him instead of
behind him, and he had come to Middlemarch
bent on doing many things that were not directly
fitted to make his fortune or even secure him a
good income.”
With not a thought for
Clinical Excellence Awards!
Lydgate’s creed
Welcome

• “Lydgate …had a youthful belief in his bread-winning
work…he carried ….the conviction that the medical
profession as it might be was the finest in the world;
presenting the most perfect interchange between
science and art; offering the most direct alliance
between intellectual conquest and the social good.”
• “He cared not only for "cases," but for
John and Elizabeth, especially Elizabeth.”
Lydgate on Clinical Medicine 1
Welcome

• “He went to study in Paris with the determination that
when …home again he would settle in some provincial
town as a general practitioner, and resist the irrational
severance between medical and surgical knowledge in
the interest of his own scientific pursuits, as well as of the
general advance:”
• “ he would keep away from the range of London
intrigues, jealousies, and social truckling, and win
celebrity, however slowly, as Jenner had done, by the
independent value of his work.”
Lydgate on Clinical Medicine 2

….The College … which gave its peculiar sanction to the
expensive and highly rarefied medical instruction obtained
by graduates of Oxford and Cambridge, did not hinder
quackery from having an excellent time of it;….
Polypharmacy by quackery not evidence-base!
Quacks
….. for since professional practice chiefly
consisted in giving a great many drugs, the
public inferred that it might be better off
with more drugs still, if they could only be
got cheaply, and hence swallowed large
cubic measures of physic prescribed by
………unscrupulous ignorance which had
taken no degrees.
Welcome

GP vs Specialists
It was clear that Lydgate, by not dispensing drugs,
intended to cast imputations on his equals, and also to
obscure the limit between his own rank as a general
practitioner and that of the physicians, who, in the
interest 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
? Empowered GP Specialists?
Welcome

The clinical Method and
? Chronic fatigue syndrome
• 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, suggested that Mr. Casaubon should go
fishing…and have a turning-room, make toys, table-legs,
and that kind of thing.
Welcome

?Chronic fatigue syndrome!
"But I don't really like attending such people
so well as the poor. The cases are more
monotonous, and one has to go through more
fuss and listen more deferentially to nonsense."
Welcome

"I believe that you are suffering from what is called fatty
degeneration of the heart, a disease which was first divined
and explored by Laennec, the man who gave us the
stethoscope…it is my duty to tell you that death from this
disease is often sudden.. Your condition may be consistent
with a tolerably comfortable life for another fifteen years, or
even more.“
Lydgate's instinct was fine enough to tell him that plain
speech, quite free from ostentatious caution, would be felt
by Mr. Casaubon as a tribute of respect.
Good Communication Skills!
Casaubon’s Diagnosis of
Heart disease

Mrs Dollop, the landlady , that people
are allowed to die in the new hospital for
the sake of cutting them up……,
Such views thwart Lydgate who has
the impulse to mercy and healing and
the ambition to research.
Post mortems
The Post Mortem was really one of the
first example of clinical audit and research
and evidence based practice
Welcome

Mrs. Dollop became more and more convinced…Dr.
Lydgate meant to let the people die in the Hospital, if not to
poison them, for the sake of cutting them up…a poor tale
for a doctor, who if he was good for anything should know
what was the matter with you before you died, and not
want to pry into your inside after you were gone. (!)
In fact Dr Lydgate was further compared to
…cutting-up of bodies, as …by…Burke and
Hare…such a hanging business as that was
not wanted in Middlemarch!
Burke and Hare
Post mortems
Welcome

It is true Lydgate was constantly visiting the
homes of the poor and adjusting his
prescriptions of diet to their small means…
Lydgate’s Public Health Aspirations
Public Health aspirations
Welcome

He was so much cheered that he began to search for an
account of experiments which he had long ago meant to look
up, and had neglected out of that creeping self-despair which
comes in the train of petty anxieties. He felt again some of
the old delightful absorption in a far-reaching inquiry… in
forgetfulness of everything except the construction of a new
controlling experiment
Lydgate a true Clinical Researcher even
contemplates controlled trials
Clinical Research Inklings

"Yes, indeed," said Mrs. Sprague. "Nobody
supposes that Mr. Lydgate can go on holding
up his head in Middlemarch, things look so
black about the thousand pounds he took just at
that man's death. It really makes one shudder."
Complaint against Lydgate
Dr Shipman type of situation
? treatment to cause death
in Raffles to benefit Bulstrode ?
Reputation besmirched
Welcome

Clinical Research : Register
No--let the new Hospital be joined with the old
Infirmary, and everything go on as it might have done if
I had never come. I have kept a valuable register since I
have been there; I shall send it to a man who will make
use of it," he ended bitterly. "I can think of nothing for a
long while but getting an income."
The only way to go to London and
abandon his living lab and research

I must do as other men do, and think
what will please the world and bring in
money; look for a little opening in the
London crowd, and push myself; set up
in a watering-place, or go to some
southern town where there are plenty of
idle English, and get myself puffed,--
that is the sort of shell I must creep into
and try to keep my soul alive in."
Lydgate Gives in to his reality
Lydgate’s decision to move
Welcome

George Eliot’s
Middlemarch:
Does it capture the
zeitgeist?
Is there relevance today
in healthcare in
Nuneaton?
….. Is it worth reading?

"This Reform will touch everybody … a thoroughly
popular measure…..a sort of A, B, C, you know, that
must come first before the rest can follow.
? Inkling of an Alphabet Strategy!
The Alphabet Strategy !

"I hope you are not one of the “Lancet's”
men, Mr. Lydgate…your words appear to point
that way."
Lancet’s Doctors
“Lancet” people! We have some!

Lancet’s Peoples !
Unsigned !
By Radicals !
DNA Technology & Rapid
Diagnosis of Infections
Catheter- Acquired UTIs

One of these reforms was to … simply prescribe, without
dispensing drugs or taking percentage from druggists.
it must … be a constant injury to the public, if their only
mode of getting paid for their work was by their making out
long bills for draughts, boluses, and mixtures.
"Why should not you have a good practice, Tertius? Mr.
Peacock had. You should be more careful not
to offend people, and you should send out
medicines as the others do….
Chief pharmacist Surinder Bassan and our
own diabetes Pharmacist Sakera Shaikh
would say so in dealings with Big Pharma
Dealing with Pharmaceutical
companies

"I am aware," he said, "that the peculiar bias of medical
ability is towards material means. Nevertheless, Mr.
Lydgate .. You recognize, I hope; the existence of spiritual
interests in your patients?“
"Certainly I do. But those words are apt to cover
different meanings to different minds.“
The question whether Mr. Tyke should be appointed as
salaried chaplain to the hospital was an exciting topic to
the Middlemarchers.
The Full Definition of
Health
George Eliot: current definitions of health:
“ Health is a state of complete physical, mental,
Spiritual and social well being and not merely
The absence of disease or infirmity
Mr. Brookes

The Full Definition of
Health
Our own Canon Edward Pogmore (MA no less!)
George Eliot: current definitions of health:
“ Health is a state of complete physical, mental,
Spiritual and social well being and not merely
The absence of disease or infirmity
Mr. Brookes

"there must be a systole and diastole in all inquiry,"
and that "a man's mind must be continually expanding
and shrinking between the whole human horizon and
the horizon of an object-glass."
What he really cared for was a medium for his work,
a vehicle for his ideas; and after all, was he not bound
to prefer the object of getting a good hospital, where he
could demonstrate the specific distinctions of fever and
test therapeutic results…
Clinical Research centered
The inkling of a clinical
research centre

• "A fine fever hospital in addition to the old infirmary
might be the nucleus of a medical school here … and
what would do more for medical education than the
spread of such schools over the country?
• A born provincial man who has a grain of public spirit
as well as a few ideas, should do what he can to
resist …. London.
• Any valid professional aims may often find a freer, if
not a richer field, in the provinces."
I.e. Why not a medical school in Warks
? Medical School

George Eliot Hospital
Education Centre
• Presentation to
Project Team
• Updated 26th August
2004

"The standard of that profession is low in
Middlemarch …" said the banker. "I mean in knowledge
and skill; not in social status…..and I have consulted
eminent men in the metropolis, and I am painfully aware
of the backwardness under which medical treatment
labours in our provincial districts."
? Surgeons only !
Backwardness in
Nuneaton ?

Lydgate …meant to (make) …..
advantageous difference to the
viscera of his own patients.
Does it seem incongruous to you
that a Middlemarch surgeon should
dream of himself as a discoverer?
Typical Surgeon

Dr Kassim Zayyan
Dr Sankar Sinha
Prof Brian Hopkinson
(Queens medical Centre, Nothingham )
• 82 yr old
• Mr JM
• Under local anesthesia
• Stent graph
• Endovascular repair of (L) internal
Iliac aneurysm
- No ITU needed !

GEDI Knights!
George Eliot Diabetes Information Sticks
Amitha Gopinath
Kelly Brogan
Terry Franklin

Some people are
forgotten !
Operating department
personnel
Ged Doyle !

Dorothea and Lydgate:
Unfinished Business in 2013?
Welcome

Dorothea and
Lydgate:
A synthesis
Conviction
Altruism
Social View
Compassion
Idealism
Dorothea Brooke
Integrity
Listener
Excellence
Research
Idealism
Dr Lydgate
A Synthesis
Welcome

Dorothea and Lydgate:
A Myers-Briggs Analysis
Conviction
Altruism
Social View
Compassion
Idealism
Dorothea Brooke
Integrity
Listener
Excellence
Research
Idealism
Dr Lydgate
A Synthesis
Obviously a successful one!

The Middlemarch Book Club
1. The Unbearable Lightness of Being by Milan Kundera
2. Among Thieves by Mez Packer
3. Slumdog Millionaire by Vikas Swarup
4. Things Fall Apart by Chinua Achebe
5. The Great Gatsby by F. Scott Fitzgerald
6. Heart of Darkness by Joseph Conrad
7. The Man in the High Castle by Philip K. Dick
8. The Road by Cormac McCarthy
9. Lolita by Vladimir Nabokov
10. Burnt Shadows by Kamila Shamsie
11. Maus by Art Spiegelman
12. The Kite Runner by Khaled Hosseini

13. The Old Man and the Sea by Ernest Hemingway
14. How Many Miles to Babylon by Jennifer Johnston
15. The Plague by Albert Camus
16. The Pearl by John Steinbeck
17. Safe Area Gorazde by Joe Sacco
18. The Alchemist by Paulo Coelho
19. Hard Boiled Wonderland and the End of the World by Haruki Murakami
20. Catcher in the Rye by JD Salinger
21. The Bonesetter’s Daughter by Amy Tan
22. The Quickening Maze by Adam Foulds
23. If Nobody Speaks of Remarkable Things: Jon McGregor
24. Saturday by Ian McEwan

23. If Nobody Speaks of Remarkable Things by Jon McGr egor
25. The Life of Pi by Jann Martell
26. Hunger by Knut Hamsun
27. To Kill a Mockingbird by Harper Lee
28. The Woman in Black by Susan Hill
29. A Town Like Alice by Neville Shute
30. A Day in the Life of Ivan Denosovitch by Alexander Solzhenitsyn
31. Other people's money by Justin Cartwright
32. The Brothers by Asko Sahlberg

23. If Nobody Speaks of Remarkable Things by Jon McGr egor
25. The Life of Pi by Jann Martell
26. Hunger by Knut Hamsun
27. To Kill a Mockingbird by Harper Lee
28. The Woman in Black by Susan Hill
29. A Town Like Alice by Neville Shute
30. A Day in the Life of Ivan Denosovitch by Alexander Solzhenitsyn
31. Other people's money by Justin Cartwright
32. The Brothers by Asko Sahlberg
33 Nemesis: Philip Roth
34 The sense of an ending: Julian Barnes
35: Salmon fishing in the Yemen: Paul Torday
36: Pure: Andrew Miller
37: The man who planted trees: Jean Giono
38: Man's World: Rupert Smith
39: Orlanda: Jacqueline Harpman

Recent Special Study Module Student 2013: MP
“By examining these characters and considering what might be driving their actions I have
developed my empathy skills.
Particularly I think it has made me less judgmental, and more able to objectively consider the
motives of the characters and therefore people in general, to consider why they might be
behaving the way they are.
This is an important change in my life in general as well as for clinical practice and so I am
pleased this has happened.”

The Local Healthcare DNA:
George Eliot Hospital, GPs and the rest of us
• What are we all about?
• Do we have innovation?
• Do we care?

DNA of George Eliot Hospital
• Heather Norgrove : recently Commercial
Director
• Worked in Primary Care for 25 years as a General
Practice/Fund holding Manager
• PCG Chief Executive in North Warwickshire, and
Director of Strategy and Commissioning for both
North Warwickshire PCT and Hinckley and Bosworth
PCT
• MBA and an MSc in Primary Health Care Studies by
research working across organisational boundaries.

• I come to bury Heather not Praise her!
• Google images:
• Heather Norgrove 5th December 2013

• Heather Norgrove :
• Galley Common remembered:
John Bland and Heather Norgrove

• Not Google images:

• Heather Norgrove :
Gloria Steinem: 1934 to still alove

Is there hope?
• Before 1890 medical provision in Nuneaton was limited
• Communicable diseases such as Typhoid, and Small Pox, and also childbirth deaths
• Manor Hospital: Dr Edward Nason, who was the Surgeon for Nuneaton
• Dr Nason administered free of charge to workhouse patients
• Edward Nason’s son Richard, commented at the time on the need for a hospital
• Especially as mines and quarries were opening up with injuries
• Mother, Alice Nason ran the Nuneaton Maternity Committee
• Lead to the Nuneaton Cottage Hospital (1893)

Is there hope?
53 year old man presents with blurred vision in his
Left eye
Patient:
• My left eye has become blurred!
Doctor
• ? Glaucoma, does it hurt?
• ? Cataract
• ? Corneal oedema
• ? Macular oedema
• ? Brain tumour…hope not!

Is there hope?
…. for the growing good of the world is partly dependent
on un-historic acts; and that things are not so ill with you
and me as they might have been, is half owing to the
number who lived faithfully a hidden life..

Quotations by George Eliot
• “I'm not denyin' the women are
foolish. God Almighty made 'em to
match the men.”
• “Blessed is the man who, having
nothing to say, abstains from giving
wordy evidence of the fact.”
• “That's what a man wants in a wife,
mostly; he wants to make sure one
fool tells him he's wise.”
Welcome

• George Eliot’s living creed- painfully arrived at – was
meliorist . We should do all we can, during a short
human lifetime, to achieve ‘some possible better’
• “The important work of moving the world forward does
not wait to be done by perfect people.”
• George Eliot reaches out to the Dorothea and Lydgate
in us all and ask us to “have a go” at improving
circumstances particularly social
around us
Conclusion and final comments

Such was Lydgate's plan of his future: to do
good small work for Middlemarch, and great
work for the world.
But let us paraphrase this to…
Our future:
to do good great work wherever you are!
Middlemarch:
A Conclusion

Middlemarch by George Eliot Prof Vinod Patel

Middlemarch by George Eliot Prof Vinod Patel

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