The medical profession, gout and comparisons with Middlemarch (Bleak House)

[kev67]

I was reminded of Middlemarch while reading chapter 17 of Bleak House. Richard Carstone does not really know what he wants to do. He decided to study to become a surgeon under Mr Badley's direction, but he is not really applying himself. Now he thinks he wants to become a lawyer. Not knowing what you want to do for a living is a common enough problem among young adults, I suppose. However, I was reminded of the chapter in Middlemarch in which Tertius Lydgate gains his love of science and sense of vocation for medicine. Like Tertius Lydgate, there is a medical man in Bleak House, called Mr Allan Woodcote. This is the man Esther Summerson is developing feelings for. Like Tertius Lygate, he is in his late twenties, but is not established enough in his profession to afford to marry. He has decided to enrol as a ship's surgeon, I suppose in order to earn some serious money.

This seems odd to me. Your late twenties is a long time to remain single. Poorer people did marry. I suppose it is best not to speculate how aspiring professional men dealt with their urges.

Gout seems a commonplace affliction in classic literature. I don't think I have ever met anyone with gout. It seems like a comic disease that afflicts the elderly and wealthy. In Bleak House, Sir Leicester Dedlock suffers from it. In Middlemarch, Tertius Lydgate finally abandons his aspirations to advance medicine for the good of society in order to satisfy his wife's expensive tastes. He writes a medical paper on gout and sets up a practice treating wealthy patients.

Another similarity between Bleak House and Middlemarch, is that Esther Summerson, like Dorothy from Middlemarch, has the ability and drive to do anything she wants, but because she is a woman, her options are limited. While Richard Carstone is having trouble deciding whether he wants to be a surgeon or a lawyer, Esther's only option is to be a house-keeper.

[Nick Capozzoli]

Gout seems a commonplace affliction in classic literature. I don't think I have ever met anyone with gout. It seems like a comic disease that afflicts the elderly and wealthy. In Bleak House, Sir Leicester Dedlock suffers from it. In Middlemarch, Tertius Lydgate finally abandons his aspirations to advance medicine for the good of society in order to satisfy his wife's expensive tastes. He writes a medical paper on gout and sets up a practice treating wealthy patients

Gout has often been portrayed in literature, especially English literature from the 17th through 19th C., as a "comic" affliction, but it is hardly a laughing matter for those who suffer from it. I suppose that it has been portrayed in this way because it often afflicted wealthy upper class folks, who tended to be well-fed, overweight, and not in the habit of engaging in much physical exercise... Indeed, those were the "risk factors" that the medical profession in those days believed were the cause of gout.

Today we have a better understanding of what causes gout. I won't bore you with the details, as you can easily find them by Googling "Gout." The fact is that gout does not afflict only affluent, overweight, and lazy folk, though the stereotype persists. G.E. was implying that Lydgate was "selling out" by choosing to "specialize" in gout to treat upper class patients, in much the same way that some folks today (rightly or wrongly) view physicians who specialize in plastic surgery or dermatology...

Like you, I was intrigued by the references to the medical profession when I read Middlemarch for a course called "19th Century Victorian Woman Novelists". That was in the early 1980's when I was a grad student at UC Berkeley. I wrote my course paper on "Victorian Medicine in Middlemarch." I thought it was fairly well argued, but the Professor apparently didn't think so, and she gave me a "B-" for the course. She felt that my approach to the novel was not "literary." To this day I believe that she felt that my approach was not adequately "feminist,' and that she either was totally ignorant of science or didn't care about it. B- was the lowest grade I'd ever gotten in a graduate or undergraduate course, so I decided right then to change course and go to med school. I've never regretted that decision.

[kev67]

Gout has often been portrayed in literature, especially English literature from the 17th through 19th C., as a "comic" affliction, but it is hardly a laughing matter for those who suffer from it. I suppose that it has been portrayed in this way because it often afflicted wealthy upper class folks, who tended to be well-fed, overweight, and not in the habit of engaging in much physical exercise... Indeed, those were the "risk factors" that the medical profession in those days believed were the cause of gout.

Today we have a better understanding of what causes gout. I won't bore you with the details, as you can easily find them by Googling "Gout." The fact is that gout does not afflict only affluent, overweight, and lazy folk, though the stereotype persists. G.E. was implying that Lydgate was "selling out" by choosing to "specialize" in gout to treat upper class patients, in much the same way that some folks today (rightly or wrongly) view physicians who specialize in plastic surgery or dermatology...

iirc, one of the main characters in the previous book I read, Matthew Bramble, the squire in Humphry Clinker suffered from it. I expect it is more easily treatable these days. Perhaps that is why we don't hear about it so often. There is a stigma to the disease. I remember an Irish comedian, Dave Allen, who told a joke that went along the lines of:

A dissolute man asks a priest what gout is. The priest sees his chance and tells him you get it from drinking, gluttony and debauchery. Why does he ask. The man says he's just read the pope has it.

It's not a brilliant joke, really, but it stuck in my mind.

Like you, I was intrigued by the references to the medical profession when I read Middlemarch for a course called "19th Century Victorian Woman Novelists". That was in the early 1980's when I was a grad student at UC Berkeley. I wrote my course paper on "Victorian Medicine in Middlemarch." I thought it was fairly well argued, but the Professor apparently didn't think so, and she gave me a "B-" for the course. She felt that my approach to the novel was not "literary." To this day I believe that she felt that my approach was not adequately "feminist,' and that she either was totally ignorant of science or didn't care about it. B- was the lowest grade I'd ever gotten in a graduate or undergraduate course, so I decided right then to change course and go to med school. I've never regretted that decision.

It seems odd that a professor who lectures on George Elliot had no interest in science, because George Elliot certainly did. I am surprised that you could switch from English to Medicine at university. I think here, if you had the A levels to be accepted on an English undergraduate course, you would be unlikely to have the A levels required for medicine.

B- would have been quite a good grade for me at school, never mind university, for an English literature essay. One of my reasons for deciding to study science and technology is that those subjects have definite correct answers.

[MANICHAEAN]

Middlemarch, like so much 19th century English literature is difficult to get out of your system once read and I see you are no exception.

On the subject of gout I was always of the impression that it was an ailment of middle aged ex-military officers who ate too much red meat and drunk port.
Later in life I was afflicted with it whilst working in Qatar. My knee was very painful, I went to hospital, a blood sample was taken and I was told my uric acid levels were too high. The doctor asked if I ate much offal. He must have been joking, for being half Irish I was raised on the likes of: tripe, kidneys, liver, trotters, stuffed hearts and even pigs head soup.. Anyway, the sacrifice has been made and I now limit myself to so called healthy foods.

[Nick Capozzoli]

...It seems odd that a professor who lectures on George Elliot had no interest in science, because George Elliot certainly did. I am surprised that you could switch from English to Medicine at university. I think here, if you had the A levels to be accepted on an English undergraduate course, you would be unlikely to have the A levels required for medicine...

It seemed odd to me, too, but she clearly either had no interest in "science" or, if she did, she didn't really understand it.

I'm not sure how it works in the UK (the A-level thing), but in the US we enter university from high school and while at university we "major" in an "undergraduate" course of study that leads to a BS or BA degree. To continue further in the university we enroll in "graduate school" for some "post-baccalaureate degree," such as a Masters or Doctoral degree. Students for the MD here apply to medical schools after completing a baccalaureate degree (usually in a science, but can be in anything) that also contains coursework in the required "pre-medical" subjects (biology, chemistry, physics, and mathematics) as well as obtaining a good grade on a standardized test (called the MCAT) of the pre-medical subject matter. In my case I took all of the required courses as an undergraduate and earned two baccalaureate degrees (one in English Lit and the other in Biology). I thought I wanted to be an English Prof, so I applied to graduate school and got accepted into the PhD program at UC Berkeley (my undergrad school). I was happy with that decision until I took this particular course. So I decided to leave. I left the program after passing my PHD "field examinations," got an MA in English Lit, and then went to med school for an MD.

[Nick Capozzoli]

Middlemarch, like so much 19th century English literature is difficult to get out of your system once read and I see you are no exception.

On the subject of gout I was always of the impression that it was an ailment of middle aged ex-military officers who ate too much red meat and drunk port.
Later in life I was afflicted with it whilst working in Qatar. My knee was very painful, I went to hospital, a blood sample was taken and I was told my uric acid levels were too high. The doctor asked if I ate much offal. He must have been joking, for being half Irish I was raised on the likes of: tripe, kidneys, liver, trotters, stuffed hearts and even pigs head soup.. Anyway, the sacrifice has been made and I now limit myself to so called healthy foods.

If you Google "Gout" you will find a good Wikipedia article on the subject. Diet is an important factor, along with genetics and kidney function. Purine-rich foods, especially organ meats, red meat, and seafood are rich in purines that metabolize to uric acid. Dehydration is an important factor in kidney function as regards urate excretion in the urine, and this can promote both kidney/bladder stones and gout. It's possible that your tour of duty in the Middle East was related to your gout attack. Alcohol consumption is also associated with gout, though it's not clear why. One possibility is that alcohol has a diuretic effect (it makes you pee a lot), which can lead to dehydration.

[kev67]

Middlemarch, like so much 19th century English literature is difficult to get out of your system once read and I see you are no exception.

On the subject of gout I was always of the impression that it was an ailment of middle aged ex-military officers who ate too much red meat and drunk port.
Later in life I was afflicted with it whilst working in Qatar. My knee was very painful, I went to hospital, a blood sample was taken and I was told my uric acid levels were too high. The doctor asked if I ate much offal. He must have been joking, for being half Irish I was raised on the likes of: tripe, kidneys, liver, trotters, stuffed hearts and even pigs head soup.. Anyway, the sacrifice has been made and I now limit myself to so called healthy foods.

That might explain why gout is not as commonplace these days. When I was growing up I was aware that there were these foodstuffs such as tripe and onion, pigs' trotters and ox's tongue. The most unpleasant sounding meal I had heard of was lamb's brain on toast.

[Jackson Richardson]

Esther isn't a paid housekeeper in the sense of being a servant: she is the member of Mr Jarndyce's family who has responsibility for the running of the household. A highly responsible position, and more satisfying for many individuals than having to go out and work for a wage.

Her goody-goodiness (O little old me, why do they think I'm so good?) is irritating. But perhaps she is making up for a deeply emotionally deprived childhood.

[kev67]

There is a contrast between Tertius Lydgate of Middlemarch and Mr Woodcourt of Bleak House. Both wanted to serve their communities, but, in Rosamund Vincy, Lydgate married a beautiful but shallow and selfish woman, who was determined not to let her social status or standard of living drop. In Esther Summerson, Woodcourt married a presumably pock-marked woman, who was, nevertheless, careful of money, hard working, very conscientious, and had a desire to do good. Woodcourt was able to serve his community, with his wife's full support. Lydgate could not.

There was another medical man in Bleak House: Harold Skimpole. The only times in the book he speaks with any candour was about Jo, the orphan with fever who was brought back to Bleak House. He is still selfish, but he is right in assessing the danger. Jo's fever could have killed, blinded or disfigured the entire household. Since Mr Bucket took Jo away to a hospital, perhaps this was the best place for him. The medical staff would be immune to smallpox (if that is what is was). Come to think of it, why wouldn't Skimpole have been vaccinated against smallpox? There has been an effective vaccine against smallpox since Edward Jenner escaped hanging after infecting a boy first with cowpox and then smallpox. Maybe Mr Bucket was vaccinated against smallpox too; otherwise it seems he risked his life in removing Jo to the hospital.