Course Hero Logo
Literature Study GuidesMiddlemarchBook 5 Chapters 43 45 Summary

Middlemarch | Study Guide

George Eliot

Get the eBook on Amazon to study offline.

Buy on Amazon Study Guide
Cite This Study Guide

How to Cite This Study Guide

quotation mark graphic


Course Hero. "Middlemarch Study Guide." Course Hero. 17 Aug. 2016. Web. 6 June 2023. <>.

In text

(Course Hero)



Course Hero. (2016, August 17). Middlemarch Study Guide. In Course Hero. Retrieved June 6, 2023, from

In text

(Course Hero, 2016)



Course Hero. "Middlemarch Study Guide." August 17, 2016. Accessed June 6, 2023.


Course Hero, "Middlemarch Study Guide," August 17, 2016, accessed June 6, 2023,

Book 5, Chapters 43–45: The Dead Hand

Course Hero Literature Instructor Russell Jaffe provides an in-depth summary and analysis of Book 5, Chapters 43–45: The Dead Hand from George Eliot's novel Middlemarch.

Middlemarch | Book 5, Chapters 43–45 : The Dead Hand | Summary



Chapter 43

Dorothea visits Lydgate to ask about her husband's condition. She finds Mrs. Lydgate at home with a guest—Ladislaw, who has recently moved to town and made friends with the couple. She feels uncomfortable about meeting Ladislaw again without being able to tell her husband. She also wonders about the propriety of his being alone with a married woman—and she begins to think that perhaps she was wrong in the past to see Ladislaw in Casaubon's absence, even if he is a relative. To Ladislaw's considerable chagrin, she departs abruptly to find Lydgate at the hospital. When Lydgate gets home Rosamund tells her husband that she thinks Ladislaw "adores" Mrs. Casaubon.

Chapter 44

Lydgate tells Dorothea that her husband wanted to know the entire truth about his condition. He then takes the opportunity to ask her for charitable aid for the hospital, which she is glad to provide from her own money. At home she tells Casaubon that she's been to see the doctor. Now that he knows she is aware of his condition, he is even more distrustful of her affection.

Chapter 45

The opposition to the fever hospital has grown, not only because people dislike Bulstrode, but also because the other medical men have joined forces against Lydgate and his innovations. The physicians—Minchin and Sprague—object to Lydgate's infringing on their territory by expecting to be paid for his services. The other surgeon-apothecaries—Toller, Wrench, and Gambit—object to his refusal to dispense drugs (and get paid for them), which he considers a conflict of interest. As a result no one will work at the new hospital. Although Lydgate has had success in treating cases, including some in which his colleagues have fallen short, many people are suspicious of his methods. Lydgate's views are also troubling to potential patients. At home Rosamund tells Lydgate that his family thinks he has fallen below them as a medical man and confides that she doesn't think medicine "is a nice profession," and he responds, "Don't say that again, dear, it pains me."


Rosamund is pleased to finally meet Dorothea. Ladislaw is less happy because he somewhat irrationally feels "caught out." Moreover, he is sensitive to the fact that Dorothea suddenly senses the "unfitness" of their free relations with each other. Finding Rosamund alone with Will makes her think that perhaps "she ought to have understood ... Mr. Casaubon did not like his cousin's visits during his own absence." Dorothea might be a little jealous as well, having set Will aside in her mind as a friend belonging particularly to her. When she gets home and tells Casaubon about her visit to the doctor, neither are able to use their shared knowledge of his sickness to draw closer to one another, because he doesn't trust her and she doesn't know how to breach his suit of armor.

Rosamund takes Will's preference for Dorothea in stride, since she is still enamored of her husband. However, she is beginning to feel the downside of his profession, which keeps him continually preoccupied and is causing him to become more unpopular in Middlemarch. Lydgate is pained by his wife's assessment: "To say that you love me without loving the medical man in me, is the same sort of thing as to say that you like eating a peach but don't like its flavor."

Lydgate knows much more about the body and disease than any of his colleagues, especially the physicians. He is also aware of the recently won legal right of surgeon-apothecaries to ask for money for their services. He is not opposed to prescribing medicine, but only to dispensing it for money, which (he believes) compromises a doctor's ethics. While it is natural that he will clash with the other doctors of Middlemarch, Lydgate draws an inordinate amount of ire because of his arrogance and refusal to pay attention to the customs and niceties of provincial life. He is too ready to give his opinion and sacrifice cooperation with others to have his own way. But he lives in a community, and his work is among the people in that community; therefore, he must gain their trust and approval if he expects to succeed. The reader can see that his "spots of commonness" are manifesting in his inability to apply his considerable intellect to social and interpersonal problems, and that his failure to do so will lead to his downfall.

Cite This Study Guide

information icon Have study documents to share about Middlemarch? Upload them to earn free Course Hero access!