There was another attraction in his profession: it wanted reform, and gave a man an opportunity for some indignant resolve to reject its venal decorations and other humbug, and to be the possessor of genuine though undemanded qualifications. He went to study in Paris with the determination that when he came 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. For it must be remembered that this was a dark period; and in spite of venerable colleges which used great efforts to secure purity of knowledge by making it scarce, and to exclude error by a rigid exclusiveness in relation to fees and appointments, it happened that very ignorant young gentlemen were promoted in town, and many more got a legal right to practise over large areas in the country. Also the high standard held up to the public mind by the College of Physicians, which gave its peculiar sanction to the expensive and highly-rarified medical instruction obtained by graduates of Oxford and Cambridge, did not hinder quackery from having an excellent time of it; 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. Considering that statistics had not yet embraced a calculation as to the number of ignorant or canting doctors which absolutely must exist in the teeth of all changes, it seemed to Lydgate that a change in the units was the most direct mode of changing the numbers. He meant to be a unit who would make a certain amount of difference towards that spreading change which would one day tell appreciably upon the averages, and in the meantime have the pleasure of making an advantageous difference to the viscera of his own patients. But he did not simply aim at a more genuine kind of practice than was common. He was ambitious of a wider effect: he was fired with the possibility that he might work out the proof of an anatomical conception and make a link in the chain of discovery.
Does it seem incongruous to you that a Middlemarch surgeon should dream of himself as a discoverer? Most of us, indeed, know little of the great originators until they have been lifted up among the constellations and already rule our fates. But that Herschel, for example, who ‘broke the barriers of the heavens’—did he not once play a provincial church-organ, and give music-lessons to stumbling pianists? Each of those Shining Ones had to walk on the earth among neighbours who perhaps thought much more of his gait and his garments than of anything which was to give him a title to everlasting fame: each of them had his little local personal history sprinkled with small temptations and sordid cares, which made the retarding friction of his course towards final companionship with the immortals. Lydgate was not blind to the dangers of such friction, but he had plenty of confidence in his resolution to avoid it as far as possible: being seven-and-twenty, he felt himself, experienced. And he was not going to have his vanities provoked by contact with the showy worldly successes of the capital, but to live among people who could hold no rivalry with that pursuit of a great idea which was to be a twin object with the assiduous practice of his profession. There was fascination in the hope that the two purposes would illuminate each other: the careful observation and inference which was his daily work, the use of the lens to further his judgment in special cases, would further his thought as an instrument of larger inquiry. Was not this the typical pre-eminence of his profession? He would be a good Middlemarch doctor, and by that very means keep himself in the track of far-reaching investigation. On one point he may fairly claim approval at this particular stage of his career: he did not mean to imitate those philanthropic models who make a profit out of poisonous pickles to support themselves while they are exposing adulteration, or hold shares in a gambling-hell that they may have leisure to represent the cause of public morality. He intended to begin in his own case some particular reforms which were quite certainly within his reach, and much less of a problem than the demonstrating of an anatomical conception. One of these reforms was to act stoutly on the strength of a recent legal decision, and simply prescribe, without dispensing drugs or taking percentage from druggists. This was an innovation for one who had chosen to adopt the style of general practitioner in a country town, and would be felt as offensive criticism by his professional brethren. But Lydgate meant to innovate in his treatment also, and he was wise enough to see that the best security for his practising honestly according to his belief was to get rid of systematic temptations to the contrary.
Perhaps that was a more cheerful time for observers and theorisers than the present; we are apt to think it the finest era of the world when America was beginning to be discovered, when a bold sailor, even if he were wrecked, might alight on a new kingdom; and about 1829 the dark territories of Pathology were a fine America for a spirited young adventurer. Lydgate was ambitious above all to contribute towards enlarging the scientific, rational basis of his profession. The more he became interested in special questions of disease, such as the nature of fever or fevers, the more keenly he felt the need for that fundamental knowledge of structure which just at the beginning of the century had been illuminated by the brief and glorious career of Bichat, who died when he was only one-and-thirty, but, like another Alexander, left a realm large enough for many heirs. That great Frenchman first carried out the conception that living bodies, fundamentally considered, are not associations of organs which can be understood by studying them first apart, and then as it were federally; but must be regarded as consisting of certain primary webs or tissues, out of which the various organs—brain, heart, lungs, and so on—are compacted, as the various accommodations of a house are built up in various proportions of wood, iron, stone, brick, zinc, and the rest, each material having its peculiar composition and proportions. No man, one sees, can understand and estimate the entire structure or its parts—what are its frailties and what its repairs, without knowing the nature of the materials. And the conception wrought out by Bichat, with his detailed study of the different tissues, acted necessarily on medical questions as the turning of gas-light would act on a dim, oil-lit street, showing new connections and hitherto hidden facts of structure which must be taken into account in considering the symptoms of maladies and the action of medicaments. But results which depend on human conscience and intelligence work slowly, and now at the end of 1829, most medical practice was still strutting or shambling along the old paths, and there was still scientific work to be done which might have seemed to be a direct sequence of Bichat’s. This great seer did not go beyond the consideration of the tissues as ultimate facts in the living organism, marking the limit of anatomical analysis; but it was open to another mind to say, have not these structures some common basis from which they have all started, as your sarsnet, gauze, net, satin, and velvet from the raw cocoon? Here would be another light, as of oxyhydrogen, showing the very grain of things, and revising all former explanations. Of this sequence to Bichat’s work, already vibrating along many currents of the European mind, Lydgate was enamoured; he longed to demonstrate the more intimate relations of living structure, and help to define men’s thought more accurately after the true order. The work had not yet been done, but only prepared for those who knew how to use the preparation. What was the primitive tissue? In that way Lydgate put the question—not quite in the way required by the awaiting answer; but such missing of the right word befalls many seekers. And he counted on quiet intervals to be watchfully seized, for taking up the threads of investigation—on many hints to be won from diligent application, not only of the scalpel, but of the microscope, which research had begun to use again with new enthusiasm of reliance. Such was Lydgate’s plan of his future: to do good small work for Middlemarch, and great work for the world.
He was certainly a happy fellow at this time: to be seven-and-twenty, without any fixed vices, with a generous resolution that his action should be beneficent, and with ideas in his