It’s tempting to characterise the host of doctors in Victorian fiction as a gallery of rogues and romantic heroes. But how do medical practitioners really feature in nineteenth-century narratives? In ‘Doctors Dissected’, a series of blog posts, I’ll be reappraising the roles they play in canonical and lesser-known novels…
Anthony Trollope, Napoleon Sarony (New York Public Library)
Inspired by the news than Julian Fellowes – creator of ITV’s beloved period drama/ cash cow Downton Abbey – has set his sights on adapting Anthony Trollope’s Doctor Thorne, I’ve decided that the latest instalment of Doctors Dissected should focus on the novel’s eponymous medical man.
It’s not difficult to see why Fellowes is attracted to the story: it has that all-important array of cross-class characters, just ripe for an ensemble cast (I’m particularly keen to see who’ll be enlisted to play the tragicomic noveaux riches Scatcherd and Son); a backdrop of rolling countryside and lavish country houses; and a plotline that gently meanders without going anywhere fast. Best of all for my research interests – and any Downton fans who feel Dr Clarkson has never had enough of a look in – it has a country practitioner as its leading man.
I’m particularly interested in the way in which Trollope both proposes and problematizes the idea of a rural doctor as his “hero”. While the opening chapter explicitly designates Thorne as such, it seems to simultaneously ironise and undermine this. Trollope appears to focus instead on the rather more glamorous figure of Frank Gresham, noting that those readers who “don’t approve of a middle-aged bachelor country doctor as a hero, may take the heir to Greshamsbury in his stead”. Frank is a rather more conventional romantic hero, a good-looking young man who spends the narrative torn between his love for Mary – the Doctor’s niece and a girl of (supposedly) modest means – and his family’s desire for him to marry money that will rejuvenate their estate. At first, Trollope appears to doubt whether the character of Doctor Thorne can rival this romantic hero for the reader’s interest.
Although he initially downplays the allure of “the modest country practitioner”, it is important to recognise that there were those who championed the rural doctor at this time. Many mid-century medical journals emphasised the courage and hard work of rural GPs, who often practised in difficult conditions, undertaking night calls and long journeys. One article in the Medical Mirror lingers upon these challenges, insisting that, “[t]here should be no better friend to the public than the man who, at all times, in all seasons, is ready to risk his own life in trying to save theirs”. However, the journal was sceptical about the prospect of public recognition, bemoaning the fact that, “[t]he country doctor’s work is for the most part hidden toil, veiled from the public because performed in the dark, and unappreciated because its exact nature and intricacies are unknown”. I am particularly interested in this idea of the doctor’s ‘hidden’ or ‘veiled’ life, and hope to examine the way in which Trollope’s novel works to confound our preconceptions of the country practitioner, by bringing his professional and personal life to the fore.
As a point of departure, it’s worth teasing out some of tensions underpinning Thorne’s position as country doctor and his standing in the community. Much has been written about the medical hierarchy, a hangover from the eighteenth century which saw the more genteel breed of physicians privileged over jobbing surgeon-apothecaries. The efforts of journals such as the Medical Mirror to celebrate the work of general practitioners (who usually fell into the latter group) can be judged as a response to this lingering prejudice. Thorne, however, presents a rather more complex hybrid. University educated and blue blooded (he’s the second cousin to a Barsetshire squire), he might be expected to enjoy a higher social standing. Yet Thorne is from a poorer branch of the family and consequently has to work for a living. Though he sets up practice in Barchester hoping to capitalise on his family connections (a sensible decision in an overcrowded medical market), we learn that his quarrels with the Thorne family over his wayward brother Henry (murdered by the time the action begins), have left him ostracised.
As a result, Thorne is a grafting medical man, with a pragmatic (rather than fashionable) approach to practice. He implements affordable pricing structures for his patients (comprising seven-and-sixpence visits for patients in a five-mile radius, with increases for those further afield) and both mixes and dispenses his own drugs. This is much to the chagrin of the other Barchester physicians, who dub him a “pseudo-doctor” and a “half-apothecary”. Medical charges and the practice of mixing medicines were thorny issues, as the medical press attests. In 1869, the Medical Times and Gazette offered a lament for “those benighted rustic regions where still the bulk of the Doctor’s income is made up by the medicine he sends out”. The journal considered this system both degrading and open to abuse, and insisted, “where it can be done, as in the higher class of practice is large towns, Medical men should be remunerated for their skill and time only”. While the MTG was sympathetic toward the struggles of the country practitioner, Thorne’s professional brothers take a rather more caustic approach.
Interestingly, this debate over medical charges rages in both lay and professional journals in the context of the novel itself. Thorne and one of his greatest rivals – Dr Fillgrave – take to attacking one another in the correspondence pages of the regional and medical press:
The guinea fee, the principle of giving advice and of selling no medicine, the great resolve to keep a distinct barrier between the physician and the apothecary, and, above all, the hatred of the contamination of a bill, were strong in the medical mind of Barsetshire. Dr Thorne had the provincial medical world against him, and so he appealed to the metropolis.
As Timothy Ziegenhagen argues in his essay on Trollope’s medical men, the novel departs from this idea that attention to the pecuniary aspects of medicine is somehow degrading. Thorne is shown to be a useful and affordable resource for the poorer patients of Barsethsire. Further, Fillgrave’s conception that the doctor “should take his fee without letting his left hand know what his right was doing”, and that “it should be taken without a thought, without a look, without a move of the facial muscle” is heavily satirised. As Ziegenhagen emphasises, Fillgrave is revealed to be a hypocrite, his mercenary interests exposed when he is shown “calculating the price of the furniture” at the home of Sir Roger Scatcherd, one of his prospective patients.
The professional rivalry between Fillgrave and Thorne is enacted in patients’ homes as well as in the press. For Fillgrave must suffer the indignity of being summoned to Scatcherd’s home, only to discover that the patient has already changed his mind about his preferred practitioner. To add insult to injury, Sir Roger’s long-suffering wife offers to pay Fillgrave for his time nonetheless, even though his professional advice has not been required. The way in which patients such as the Scatcherds and the Greshams flit between different practitioners is an accurate reflection of the power enjoyed by richer patients. Arguably, Trollope focuses on Thorne’s interactions with wealthier patients in order to draw out some of the class tensions inherent in his role. It also allows him to demonstrate Thorne’s unconventional (and occasionally unpopular) bedside manner. He is described as “brusque” and “authoritative”, with “not much in his individual manner to recommend him to the favour of ladies”. Nevertheless, Trollope is quick to assuage our fears by insisting that “to real suffering no one found him brusque” and “no patient lying painfully on a bed of sickness ever found him rough”.
In Between Doctors and Patients: The Changing Balance of Power, Lilian Furst emphasises Thorne’s role as “confidential friend” to his patients. While Sir Roger does not always appreciate the doctor’s heavy-handed attempts to curb his alcoholism, he is the man’s “solitary friend”. Though they have “nothing in unison”, the self-made Sir Roger trusts Thorne like “he trusted no other living creature on earth”. Meanwhile, although Lady Arabella Gresham (Frank’s mother) deems him “arrogant” and “deficient as to properly submissive demeanour towards herself” she also “trust[s] in him as a medical man”. It is this trust which sees both patients ultimately reconciled with Thorne. Significantly, the recalcitrant Lady Gresham returns to Thorne on the advice of her London consultant, Sir Omnicrom Pie. Trollope thus illustrates how the relationship between medical professionals could be collaborative as well as combative.
The doctor/patient relationship between Arabella and Doctor Thorne is complicated by the novel’s marriage plot. For Lady Gresham is preoccupied with finding a suitably wealthy partner for her son, and is aghast when she learns of his flirtation with the doctor’s niece, Mary. She unwisely accuses the girl of initiating the flirtation, thus incurring Thorne’s wrath and jeopardising the long-running personal and professional ties between the families. It is clear that though Thorne is deemed a suitable confidant and competent practitioner, his niece is considered (by Arabella, at least) unworthy of the hand of the Greshamsbury heir. Lady Gresham’s prejudice is mined for much dramatic irony, for the reader (like Thorne) knows that Mary has worth well beyond her virtue. While her secret lineage is a somewhat mixed bag – she’s the product of an illicit union between Thorne’s brother, and the sister of a stone-mason – we also know she’s in line to inherit unparalleled wealth. Her other uncle is Sir Roger, who is dying of alcoholism. Next in line to his considerable fortune is his equally inebriated son, Louis. If neither man survives, Mary will inherit a fortune including – in a brilliant twist of irony – Lord Gresham’s debts.
For much of the narrative, these circumstances are kept hidden by Thorne. In some sense, this seems a heroic project: he doesn’t want the Greshams to learn of Mary’s material value, because he wishes them to accept her as their daughter-in-law on her own terms. He is also at pains to prevent Mary from discovering the truth, lest she form any family ties with the Scatcherd side of her bloodline. Though Roger is a friend of Thorne’s, and far from wholly dissipated, the doctor feels he is hardly a fit connection for a young woman.
Nevertheless, there are definite cracks in Thorne’s valiant veneer. His desire to keep Mary and the Scatcherds apart is driven (at least in part) by snobbery. As we learn at the beginning of the novel, “[n]o man plumed himself on good blood more than Doctor Thorne; no man had greater pride in his genealogical tree”. This pride prevents him from showing deference towards his supposed social superiors (a trait we may well applaud him for), but it can also result in stubbornness. He is shown to be repeatedly at war with others. “If there was on Dr Thorne’s cranium one bump more developed than another”, Trollope comments, “it was than of combativeness”. Further, the way in which Dr Thorne takes it upon himself to conceal Mary’s lineage and prospects perhaps betrays a desire to ‘play God’. Almost fully convinced of his own righteousness, he barely pauses to consider allowing Mary to make her own (fully-informed) decisions. He does not entrust her to define the terms of her relationship with the Scatcherds, nor does he allow her and Frank to plan their life around Mary’s likely prospects. One might wonder if Thorne’s experiences as a doctor have shaped this paternalistic attitude, or if this self-righteousness and sense of pride has moulded his bedside manner.
Throughout the novel, Thorne’s professional and personal lives are fully enmeshed, his obligations to the Greshams and the Scatcherds as patients compromised by his private affairs. His relationship with the Gresham family – governed by the unfolding marriage plot – comes to dominate much of the story, and probably will the ITV version. It is not difficult to imagine Fellowes delighting in the chance to stage a conflict between a haughty high society lady and the country practitioner. However, Thorne’s interactions with the Scatcherds are equally interesting, and perhaps more provocative. While Thorne tends to both Roger and his son – even in their darkest hours – the reader is all too aware that his niece’s financial security is ultimately dependent on these patients’ deaths. The doctor’s duty to preserve life thus comes into conflict with his obligations to ensure the security of his beloved niece. Of course, Trollope is writing in a romantic-realist – rather than a sensationalist – vein, and thus Thorne’s medical ethics are never really in doubt – he does not allow his self-interest to trump the care of his patients. Indeed, he goes to great pains to try and protect the self-destructive Scatcherds, particularly when Sir Roger asks him to act in loco parentis to the wayward Louis after his death. As Furst argues, his “willingness to accept this troublesome charge against his inner inclinations tells us much about the doctor’s sense of obligation”.
For Furst, it is Thorne’s “loyalty, perseverance, and selflessness” than enable to him to “fully earn […] the title of ‘hero’ ”. Similarly, Ziegenhagen argues that Thorne is Trollope’s “ideal professional” because he “works hard” and “provides a valuable service”. He cites as his primary evidence the fact that Thorne continues to work at the end of the novel. Rather than retiring and enjoying the comforts provided by his niece’s newly acquired wealth, he instead “extend[s] his practice, to the great disgust of Dr Fillgrave”. While Ziegenhagen lauds the fact that work “gives meaning to [Thorne’s] day-to-day existence”, I wish to dwell on the suggestion that this will inflame his rival. For this aside seems a final nod towards Thorne’s somewhat acerbic nature. It is a reminder that he is a successful and popular doctor, but that he cannot help ruffling some feathers. For me, Thorne’s heroism is not defined by his beneficence but by his difficult personal character; he piques our interest by the challenges he faces. Ultimately, it is by exposing the tumultuous nature of Thorne’s “hidden” or “veiled” life that Trollope makes him so much more than that “modest country medical practitioner” of the novel’s opening line.
Image credit: Henry W. and Albert A. Berg Collection of English and American Literature, The New York Public Library. “A. Trollope.” The New York Public Library Digital Collections. http://digitalcollections.nypl.org/items/510d47db-c5cb-a3d9-e040-e00a18064a99
[Editorial], Medical Times and Gazette, 4 December 1869, pp. 661-2.
Furst, Lilian R., Between Doctors and Patients: The Changing Balance of Power (Virginia: University of Virginia Press, 1998).
“The Country Doctor and his Work”, Medical Mirror, 1 November 1870, p. 195.
Trollope, Anthony (1858), Doctor Thorne (London: Penguin Books, 2012).
Ziegenhagen, Timothy, “Trollope’s Professional Gentleman: Medical Training and Medical Practice in Doctor Thorne and The Warden“, Studies in the Novel, 38, 2 (Summer 2006).