Middlemarch - 53

Hence Mr. Gambit could go away from the chief grocer’s without fear of rivalry, but not without a sense that Lydgate was one of those hypocrites who try to discredit others by advertising their own honesty, and that it might be worth some people’s while to show him up. Mr. Gambit, however, had a satisfactory practice, much pervaded by the smells of retail trading which suggested the reduction of cash payments to a balance. And he did not think it worth his while to show Lydgate up until he knew how. He had not indeed great resources of education, and had had to work his own way against a good deal of professional contempt; but he made none the worse accoucheur for calling the breathing apparatus “longs.”

Other medical men felt themselves more capable. Mr. Toller shared the highest practice in the town and belonged to an old Middlemarch family: there were Tollers in the law and everything else above the line of retail trade. Unlike our irascible friend Wrench, he had the easiest way in the world of taking things which might be supposed to annoy him, being a well-bred, quietly facetious man, who kept a good house, was very fond of a little sporting when he could get it, very friendly with Mr. Hawley, and hostile to Mr. Bulstrode. It may seem odd that with such pleasant habits he should have been given to the heroic treatment, bleeding and blistering and starving his patients, with a dispassionate disregard to his personal example; but the incongruity favored the opinion of his ability among his patients, who commonly observed that Mr. Toller had lazy manners, but his treatment was as active as you could desire: no man, said they, carried more seriousness into his profession: he was a little slow in coming, but when he came, he did something. He was a great favorite in his own circle, and whatever he implied to any one’s disadvantage told doubly from his careless ironical tone.

He naturally got tired of smiling and saying, “Ah!” when he was told that Mr. Peacock’s successor did not mean to dispense medicines; and Mr. Hackbutt one day mentioning it over the wine at a dinner-party, Mr. Toller said, laughingly, “Dibbitts will get rid of his stale drugs, then. I’m fond of little Dibbitts—I’m glad he’s in luck.”

“I see your meaning, Toller,” said Mr. Hackbutt, “and I am entirely of your opinion. I shall take an opportunity of expressing myself to that effect. A medical man should be responsible for the quality of the drugs consumed by his patients. That is the rationale of the system of charging which has hitherto obtained; and nothing is more offensive than this ostentation of reform, where there is no real amelioration.”

“Ostentation, Hackbutt?” said Mr. Toller, ironically. “I don’t see that. A man can’t very well be ostentatious of what nobody believes in. There’s no reform in the matter: the question is, whether the profit on the drugs is paid to the medical man by the druggist or by the patient, and whether there shall be extra pay under the name of attendance.”

“Ah, to be sure; one of your damned new versions of old humbug,” said Mr. Hawley, passing the decanter to Mr. Wrench. 

Mr. Wrench, generally abstemious, often drank wine rather freely at a party, getting the more irritable in consequence.

“As to humbug, Hawley,” he said, “that’s a word easy to fling about. But what I contend against is the way medical men are fouling their own nest, and setting up a cry about the country as if a general practitioner who dispenses drugs couldn’t be a gentleman. I throw back the imputation with scorn. I say, the most ungentlemanly trick a man can be guilty of is to come among the members of his profession with innovations which are a libel on their time-honored procedure. That is my opinion, and I am ready to maintain it against any one who contradicts me.” Mr. Wrench’s voice had become exceedingly sharp.

“I can’t oblige you there, Wrench,” said Mr. Hawley, thrusting his hands into his trouser-pockets.

“My dear fellow,” said Mr. Toller, striking in pacifically, and looking at Mr. Wrench, “the physicians have their toes trodden on more than we have. If you come to dignity it is a question for Minchin and Sprague.”

“Does medical jurisprudence provide nothing against these infringements?” said Mr. Hackbutt, with a disinterested desire to offer his lights. “How does the law stand, eh, Hawley?”

“Nothing to be done there,” said Mr. Hawley. “I looked into it for Sprague. You’d only break your nose against a damned judge’s decision.”

“Pooh! no need of law,” said Mr. Toller. “So far as practice is concerned the attempt is an absurdity. No patient will like it—certainly not Peacock’s, who have been used to depletion. Pass the wine.”

Mr. Toller’s prediction was partly verified. If Mr. and Mrs. Mawmsey, who had no idea of employing Lydgate, were made uneasy by his supposed declaration against drugs, it was inevitable that those who called him in should watch a little anxiously to see whether he did “use all the means he might use” in the case. Even good Mr. Powderell, who in his constant charity of interpretation was inclined to esteem Lydgate the more for what seemed a conscientious pursuit of a better plan, had his mind disturbed with doubts during his wife’s attack of erysipelas, and could not abstain from mentioning to Lydgate that Mr. Peacock on a similar occasion had administered a series of boluses which were not otherwise definable than by their remarkable effect in bringing Mrs. Powderell round before Michaelmas from an illness which had begun in a remarkably hot August. At last, indeed, in the conflict between his desire not to hurt Lydgate and his anxiety that no “means” should be lacking, he induced his wife privately to take Widgeon’s Purifying Pills, an esteemed Middlemarch medicine, which arrested every disease at the fountain by setting to work at once upon the blood. This co-operative measure was not to be mentioned to Lydgate, and Mr. Powderell himself had no certain reliance on it, only hoping that it might be attended with a blessing.

But in this doubtful stage of Lydgate’s introduction he was helped by what we mortals rashly call good fortune. I suppose no doctor ever came newly to a place without making cures that surprised somebody—cures which may be called fortune’s testimonials, and deserve as much credit as the written or printed kind. Various patients got well while Lydgate was attending them, some even of dangerous illnesses; and it was remarked that the new doctor with his new ways had at least the merit of bringing people back from the brink of death. The trash talked on such occasions was the more vexatious to Lydgate, because it gave precisely the sort of prestige which an incompetent and unscrupulous man would desire, and was sure to be imputed to him by the simmering dislike of the other medical men as an encouragement on his own part of ignorant puffing. But even his proud outspokenness was checked by the discernment that it was as useless to fight against the interpretations of ignorance as to whip the fog; and “good fortune” insisted on using those interpretations.

Mrs. Larcher having just become charitably concerned about alarming symptoms in her charwoman, when Dr. Minchin called, asked him to see her then and there, and to give her a certificate for the Infirmary; whereupon after examination he wrote a statement of the case as one of tumor, and recommended the bearer Nancy Nash as an out-patient. Nancy, calling at home on her way to the Infirmary, allowed the stay maker and his wife, in whose attic she lodged, to read Dr. Minchin’s paper, and by this means became a subject of compassionate conversation in the neighboring shops of Churchyard Lane as being afflicted with a tumor at first declared to be as large and hard as a duck’s egg, but later in the day to be about the size of “your fist.” Most hearers agreed that it would have to be cut out, but one had known of oil and another of “squitchineal” as adequate to soften and reduce any lump in the body when taken enough of into the inside—the oil by gradually “soopling,” the squitchineal by eating away.

Meanwhile when Nancy presented herself at the Infirmary, it happened to be one of Lydgate’s days there. After questioning and examining her, Lydgate said to the house-surgeon in an undertone, “It’s not tumor: it’s cramp.” He ordered her a blister and some steel mixture, and told her to go home and rest, giving her at the same time a note to Mrs. Larcher, who, she said, was her best employer, to testify that she was in need of good food.

But by-and-by Nancy, in her attic, became portentously worse, the supposed tumor having indeed given way to the blister, but only wandered to another region with angrier pain. The staymaker’s wife went to fetch Lydgate, and he continued for a fortnight to attend Nancy in her own home, until under his treatment she got quite well and went to work again. But the case continued to be described as one of tumor in Churchyard Lane and other streets—nay, by Mrs. Larcher also; for when Lydgate’s remarkable cure was mentioned to Dr. Minchin, he naturally did not like to say, “The case was not one of tumor, and I was mistaken in describing it as such,” but answered, “Indeed! ah! I saw it was a surgical case, not of a fatal kind.” He had been inwardly annoyed, however, when he had asked at the Infirmary about the woman he had recommended two days before, to hear from the house-surgeon, a youngster who was not sorry to vex Minchin with impunity, exactly what had occurred: he privately pronounced that it was indecent in a general practitioner to contradict a physician’s diagnosis in that open manner, and afterwards agreed with Wrench that Lydgate was disagreeably inattentive to etiquette. Lydgate did not make the affair a ground for valuing himself or (very particularly) despising Minchin, such rectification of misjudgments often happening among men of equal qualifications. But report took up this amazing case of tumor, not clearly distinguished from cancer, and considered the more awful for being of the wandering sort; till much prejudice against Lydgate’s method as to drugs was overcome by the proof of his marvellous skill in the speedy restoration of Nancy Nash after she had been rolling and rolling in agonies from the presence of a tumor both hard and obstinate, but nevertheless compelled to yield.

How could Lydgate help himself? It is offensive to tell a lady when she is expressing her amazement at your skill, that she is altogether mistaken and rather foolish in her amazement. And to have entered into the nature of diseases would only have added to his breaches of medical propriety. Thus he had to wince under a promise of success given by that ignorant praise which misses every valid quality.

In the case of a more conspicuous patient, Mr. Borthrop Trumbull, Lydgate was conscious of having shown himself something better than an every-day doctor, though here too it was an equivocal advantage that he won. The eloquent auctioneer was seized with pneumonia, and having been a patient of Mr. Peacock’s, sent for Lydgate, whom he had expressed his intention to patronize. Mr Trumbull was a robust man, a good subject for trying the expectant theory upon—watching the course of an interesting disease when left as much as possible to itself, so that the stages might be noted for future guidance; and from the air with which he described his sensations Lydgate surmised that he would like to be taken into his medical man’s confidence, and be represented as a partner in his own cure. The auctioneer heard, without much surprise, that his was a constitution which (always with due watching) might be left to itself, so as to offer a beautiful example of a disease with all its phases seen in clear delineation, and that he probably had the rare strength of mind voluntarily to become the test of a rational procedure, and thus make the disorder of his pulmonary functions a general benefit to society.

Mr. Trumbull acquiesced at once, and entered strongly into the view that an illness of his was no ordinary occasion for medical science.

“Never fear, sir; you are not speaking to one who is altogether ignorant of the vis medicatrix,” said he, with his usual superiority of expression, made rather pathetic by difficulty of breathing. And he went without shrinking through his abstinence from drugs, much sustained by application of the thermometer which implied the importance of his temperature, by the sense that he furnished objects for the microscope, and by learning many new words which seemed suited to the dignity of his secretions. For Lydgate was acute enough to indulge him with a little technical talk.

It may be imagined that Mr. Trumbull rose from his couch with a disposition to speak of an illness in which he had manifested the strength of his mind as well as constitution; and he was not backward in awarding credit to the medical man who had discerned the quality of patient he had to deal with. The auctioneer was not an ungenerous man, and liked to give others their due, feeling that he could afford it. He had caught the words “expectant method,” and rang chimes on this and other learned phrases to accompany the assurance that Lydgate “knew a thing or two more than the rest of the doctors—was far better versed in the secrets of his profession than the majority of his compeers.”

This had happened before the affair of Fred Vincy’s illness had given to Mr. Wrench’s enmity towards Lydgate more definite personal ground. The new-comer already threatened to be a nuisance in the shape of rivalry, and was certainly a nuisance in the shape of practical criticism or reflections on his hard-driven elders, who had had something else to do than to busy themselves with untried notions. His practice had spread in one or two quarters, and from the first the report of his high family had led to his being pretty generally invited, so that the other medical men had to meet him at dinner in the best houses; and having to meet a man whom you dislike is not observed always to end in a mutual attachment. There was hardly ever so much unanimity among them as in the opinion that Lydgate was an arrogant young fellow, and yet ready for the sake of ultimately predominating to show a crawling subservience to Bulstrode. That Mr. Farebrother, whose name was a chief flag of the anti-Bulstrode party, always defended Lydgate and made a friend of him, was referred to Farebrother’s unaccountable way of fighting on both sides.

Here was plenty of preparation for the outburst of professional disgust at the announcement of the laws Mr. Bulstrode was laying down for the direction of the New Hospital, which were the more exasperating because there was no present possibility of interfering with his will and pleasure, everybody except Lord Medlicote having refused help towards the building, on the ground that they preferred giving to the Old Infirmary. Mr. Bulstrode met all the expenses, and had ceased to be sorry that he was purchasing the right to carry out his notions of improvement without hindrance from prejudiced coadjutors; but he had had to spend large sums, and the building had lingered. Caleb Garth had undertaken it, had failed during its progress, and before the interior fittings were begun had retired from the management of the business; and when referring to the Hospital he often said that however Bulstrode might ring if you tried him, he liked good solid carpentry and masonry, and had a notion both of drains and chimneys. In fact, the Hospital had become an object of intense interest to Bulstrode, and he would willingly have continued to spare a large yearly sum that he might rule it dictatorially without any Board; but he had another favorite object which also required money for its accomplishment: he wished to buy some land in the neighborhood of Middlemarch, and therefore he wished to get considerable contributions towards maintaining the Hospital. Meanwhile he framed his plan of management. The Hospital was to be reserved for fever in all its forms; Lydgate was to be chief medical superintendent, that he might have free authority to pursue all comparative investigations which his studies, particularly in Paris, had shown him the importance of, the other medical visitors having a consultative influence, but no power to contravene Lydgate’s ultimate decisions; and the general management was to be lodged exclusively in the hands of five directors associated with Mr. Bulstrode, who were to have votes in the ratio of their contributions, the Board itself filling up any vacancy in its numbers, and no mob of small contributors being admitted to a share of government.

There was an immediate refusal on the part of every medical man in the town to become a visitor at the Fever Hospital.

“Very well,” said Lydgate to Mr. Bulstrode, “we have a capital house-surgeon and dispenser, a clear-headed, neat-handed fellow; we’ll get Webbe from Crabsley, as good a country practitioner as any of them, to come over twice a-week, and in case of any exceptional operation, Protheroe will come from Brassing. I must work the harder, that’s all, and I have given up my post at the Infirmary. The plan will flourish in spite of them, and then they’ll be glad to come in. Things can’t last as they are: there must be all sorts of reform soon, and then young fellows may be glad to come and study here.” Lydgate was in high spirits.

“I shall not flinch, you may depend upon it, Mr. Lydgate,” said Mr. Bulstrode. “While I see you carrying out high intentions with vigor, you shall have my unfailing support. And I have humble confidence that the blessing which has hitherto attended my efforts against the spirit of evil in this town will not be withdrawn. Suitable directors to assist me I have no doubt of securing. Mr. Brooke of Tipton has already given me his concurrence, and a pledge to contribute yearly: he has not specified the sum—probably not a great one. But he will be a useful member of the board.”

A useful member was perhaps to be defined as one who would originate nothing, and always vote with Mr. Bulstrode.

The medical aversion to Lydgate was hardly disguised now. Neither Dr. Sprague nor Dr. Minchin said that he disliked Lydgate’s knowledge, or his disposition to improve treatment: what they disliked was his arrogance, which nobody felt to be altogether deniable. They implied that he was insolent, pretentious, and given to that reckless innovation for the sake of noise and show which was the essence of the charlatan.

The word charlatan once thrown on the air could not be let drop. In those days the world was agitated about the wondrous doings of Mr. St. John Long, “noblemen and gentlemen” attesting his extraction of a fluid like mercury from the temples of a patient.