Middlemarch by George Eliot Prof Vinod Patel
- 1. 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
- 2. 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
- 3. 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 !
- 4. 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
- 5. 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.[
- 6. Head of communication and marketing – Nigel Lucas “had nightmares about Middlemarch…it was horrendous! …I was forced to read it
- 7. 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
- 8. 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
- 9. 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
- 10. 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.
- 11. George Eliot A woman in advance of her time • 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!
- 12. George Eliot A woman in advance of her time • 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
- 13. George Eliot A woman in advance of her time • 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
- 14. George Eliot A woman in advance of her time • 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
- 15. George Eliot A woman in advance of her time • 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
- 16. 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)
- 17. 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.
- 18. 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.
- 19. 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
- 20. Middlemarch; A synopsis Your Character from literature and idea in relation to medical humanities Welcome
- 21. 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
- 22. Middlemarch; A synopsis Dorothea Brookes • 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
- 23. Middlemarch; A synopsis Dr Tertius Lydgate Welcome
- 24. Middlemarch; A synopsis Dr Tertius Lydgate • 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
- 25. Middlemarch; A synopsis Dr Tertius Lydgate • “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
- 26. Middlemarch; A synopsis Dr Tertius Lydgate • 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
- 27. Middlemarch; A synopsis Dr Tertius Lydgate • 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!
- 28. • 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
- 29. "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!
- 30. "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
- 31. 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.
- 32. Middlemarch SSC Timetable 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.
- 33. Middlemarch SSC Timetable 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
- 34. Middlemarch SSC Timetable 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
- 35. 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
- 36. Middlemarch SSC Timetable 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
- 37. 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.
- 38. Middlemarch SSC Timetable 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.
- 39. Middlemarch SSC Timetable 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.
- 40. Middlemarch SSC Timetable 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
- 41. Middlemarch SSC Timetable 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.
- 42. Middlemarch SSC Timetable 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.
- 43. 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
- 44. Middlemarch; A synopsis Dorothea Brookes Welcome
- 45. 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
- 46. Middlemarch; A synopsis Dorothea Brookes • 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
- 47. Middlemarch; A synopsis Dr Tertius Lydgate Welcome
- 48. Middlemarch; A synopsis Dr Tertius Lydgate • 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
- 49. Middlemarch; A synopsis Dr Tertius Lydgate • “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
- 50. Middlemarch; A synopsis Dr Tertius Lydgate • 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
- 51. Middlemarch; A synopsis Dr Tertius Lydgate • 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!
- 52. • 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
- 53. "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!
- 54. "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
- 56. • “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
- 57. • "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
- 58. “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
- 59. • “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
- 60. • “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
- 61. ….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
- 62. 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
- 63. 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
- 64. ?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
- 65. "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
- 66. 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
- 67. 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
- 68. 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
- 69. 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
- 70. "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
- 71. 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
- 72. 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
- 73. George Eliot’s Middlemarch: Does it capture the zeitgeist? Is there relevance today in healthcare in Nuneaton? ….. Is it worth reading?
- 74. "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 !
- 75. "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!
- 76. Lancet’s Peoples ! Unsigned ! By Radicals ! DNA Technology & Rapid Diagnosis of Infections Catheter- Acquired UTIs
- 77. 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
- 78. "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
- 79. 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
- 80. "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
- 81. • "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
- 82. George Eliot Hospital Education Centre • Presentation to Project Team • Updated 26th August 2004
- 86. "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 ?
- 87. 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
- 89. 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 !
- 90. GEDI Knights! George Eliot Diabetes Information Sticks Amitha Gopinath Kelly Brogan Terry Franklin
- 94. Some people are forgotten ! Operating department personnel Ged Doyle !
- 95. Dorothea and Lydgate: Unfinished Business in 2013? Welcome
- 96. The Twist!
- 97. Dorothea and Lydgate: A synthesis Conviction Altruism Social View Compassion Idealism Dorothea Brooke Integrity Listener Excellence Research Idealism Dr Lydgate A Synthesis Welcome
- 98. 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!
- 99. The Middlemarch Book Club
- 100. 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
- 101. 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
- 102. 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 by Jon McGr egor 24. Saturday by Ian McEwan 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
- 103. 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 by Jon McGr egor 24. Saturday by Ian McEwan 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
- 104. The Middlemarch Book Club 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.”
- 105. 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?
- 106. 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.
- 107. DNA of George Eliot Hospital • I come to bury Heather not Praise her! • Google images: • Heather Norgrove 5th December 2013
- 108. DNA of George Eliot Hospital • Heather Norgrove : • I come to bury Heather not Praise her! • Galley Common remembered: John Bland and Heather Norgrove
- 109. DNA of George Eliot Hospital • I come to bury Heather not Praise her! • Not Google images:
- 110. DNA of George Eliot Hospital • Heather Norgrove : Gloria Steinem: 1934 to still alove
- 111. 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)
- 112. 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!
- 113. Is there hope?
- 114. Is there hope?
- 115. 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..
- 116. 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
- 117. • 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
- 118. 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