Dorothea visits Lydgate's home to ask if Casaubon consulted him because of new health problems. Lydgate is not home, but she discovers that Will is there visiting with Rosamond. Will offers to go to the New Hospital to fetch Lydgate, but Dorothea chooses to go to the hospital herself. She does not want to speak with Will, because she knows she could not tell Casaubon about it without upsetting him. She also doesn't want to hide things from her husband. She wonders why Will visits Rosamond in Lydgate's absence. Dorothea's abrupt departure mortifies Will, and he suspects he has fallen in her opinion. Rosamond teases Will by saying he worships Dorothea. Rosamond wonders at the possibilities of having male admirers even as a married woman.

Lydgate sets Dorothea's mind to rest about Casaubon's health. He converses with her about the petty politics hindering his fund-raising efforts for the hospital. He names Bulstrode's unpopularity as the chief reason. He regrets wasting time on political differences when he'd rather be working on medical issues. Dorothea donates some money to the hospital.

Public opinion of Lydgate's support of reform of the medical profession is divided. Lydgate's sparing use of drugs arouses distrust in potential patients, professional jealousy in other doctors, and anger in the local apothecaries. His habit of sometimes contradicting other doctors' methods angers and embarrasses his colleagues. However, Lydgate's successful treatment of some serious illnesses balances the public distrust somewhat.

Bulstrode would be happy to pay for everything at the hospital in return for the exclusive right to manage it, except for the fact that he wishes to purchase Stone Court from Joshua Rigg Featherstone. Therefore, he must secure large donations for the hospital. He gives Lydgate full authority over the treatment of the patients. Other doctors can consult, but they cannot contravene Lydgate's decisions. Every medical man in town refuses to visit the Fever Hospital.

Rosamond tells Lydgate that she wishes he weren't a medical man. She says that his titled relatives feel that he has sunk below them in his choice of a profession. Lydgate tells her that she cannot love him if she can't love the medical man in him.

Public opinion of Ladislaw generally conforms to Casaubon's. The rumor has gotten out that they are relatives, but that Casaubon will have nothing to do with him. Many find him brash, ridiculous, and perhaps a little dangerous. However, he is friendly with some households, including Farebrother's, where he is a favorite of the ladies, especially Miss Noble. He visits the Lydgates frequently and alleviates Rosamond's boredom. Lydgate is out of temper because he has been unable to pay the debt he owes on his furniture, and Rosamond is pregnant.

Casaubon suspects that Will plans to fool Dorothea into marrying him when she becomes a widow in order to get possession of his wealth. However, Will worships Dorothea for other reasons. He wonders what his devotion means to her. He plans to go to Lowick Church during services in order to catch a glimpse of her, even though it would be an outright defiance of Casaubon's prohibition. He goes nevertheless, but he regrets his impetuous action immediately because Dorothea pales when she sees him.

Dorothea is upset that her husband continues in refusing to speak to Will. His presence in the Church only more strongly marks their alienation. Casaubon's health continues to decline. Later that night, Casaubon asks Dorothea to make a promise. She asks what the promise is. Casaubon thinks her question is a refusal. She asks him to defer the matter until the next morning. In the morning Casaubon takes a walk. Dorothea resolves to promise whatever Casaubon wants and searches for him on the grounds. She finds him seated on a bench and discovers that he has died.


Lydgate experiences problems when he continues to ignore the importance of social relations. He concentrates so strongly on reforming the practice of medicine in Middlemarch that he fails to realize the importance of establishing cordial relationships with his colleagues. His professional life cannot be independent of the web of social relations. His resistance to dispensing drugs threatens the livelihood of the local apothecaries. Ironically, it threatens Lydgate's livelihood as well, because potential patients distrust his treatment, as they are accustomed to receiving drugs.

Lydgate doesn't treat his patients like interesting case studies, but as individual human lives. To him, they represent the virtue of improving medicine. He alleviates human misery, rather than merely curing disease. His vocation doesn't represent an abstract academic pursuit. However, he treats the community of Middlemarch as a passive body on which he can experiment with his reforms. His refusal to recognize the human aspect of the web of multiple social relations entails consequences. His success in difficult cases only goes so far to amend his unpopularity. Lydgate's professional success depends on a combination of professional merit and skilled social networking.

Moreover, Lydgate assumes his professional life will be separate from his married life. Even though he heralds a very modern concept of medicine and science, he entertains old-fashioned ideas about marriage. He expects his wife to be a passive ornament to his life. He also does not realize that his professional success is extremely important for his private married life. The two do not exist independent of one another.

Rosamond's dream is to live an aristocratic lifestyle. The narrow range of possibilities for self-realization available to women is perhaps partly responsible for Rosamond's manipulative nature. She can achieve her dream only through a man. She certainly cannot attempt to earn a fortune on her own, as a man might. She has never received an education that would even prepare her for such a life. Her intelligence and her ability to manage people degenerate into selfish vanity in the stunted environment available to women. There is no other outlet for her ambitions. She directs her ambition for upward social mobility into plans to manipulate her husband into leaving Middlemarch. Conventional gender roles stifle Rosamond's natural ambition, and because of her frustrated ambition, both she and her husband are miserable. Her only outlet for this ambition is her husband. He treats her like an object, and she treats him like an object to be manipulated as a means to fulfill her goals.

Like Rosamond's father, Lydgate conceals money matters from Rosamond. Moreover, he has begun to realize that his ideal woman is not the best wife for him. He thought he wanted a sheltered ornament. He married such a woman only to discover that he actually needs a partner, because he cannot afford to shelter her figuratively or literally. He feels unable to mention his money troubles to Rosamond. Bearing the burden alone creates an endless cycle of anxiety and misery.

Casaubon pursues a similar path with Dorothea. He treats her like a child because he resolves to "protect" her from Will's supposedly ulterior motives. He convinces himself that Will wants to get Dorothea's money. A woman's safety is a man's concern, not her own.

Dorothea's idealization of self-sacrificing virtue comes to an end. She has tried to submit to Casaubon in accordance with this moral system. However, her idealization of self-sacrifice actually arises from a suppressed pride. She expects appreciation for her submissive self-sacrifice. However, Casaubon considers her self-sacrificing submission part of her duty as a wife, not a mark of extraordinary virtue. He drains Dorothea's vitality and happiness out of her, and she increases his anxieties and self-doubts. The juxtaposed metaphors of youth and death used to describe them come to take on a morbid quality. Casaubon's unnamed promise bears a strong symbolic relationship to the structure of their marriage. Dorothea is never able to agree to his promise. She will never be able to make him happy. His unnamed need haunts her, because she will never be able to please him. The unnamed promise symbolizes the inability of both to fulfill their idealized expectations of one another. It is a promise never spoken, but one that inevitably will be broken.

Once Casaubon cuts him off, Will too must face the need to earn his own living. His driving ambition is social and political reform. He works on Brooke's campaign. His position illustrates the precarious position of the disinherited ambitious young man. He does not have the money to run for election himself, so he must work in someone else's election. His ambitions must be mediated through another, wealthier man.