Middlemarch is a middle-sized country town typical of rural British life in the early nineteenth century. George Eliot (born Mary Ann Evans) was part of the realist school that dominated Victorian literature. She tried to create a true representation of the real, historical lives of ordinary people.

The novel has a vast number of characters and events but most of the plot centers on two couples: Dorothea and Casaubon (later Will Ladislaw) and Rosamond and Lydgate. Dorothea is an intelligent, vigorous woman, eager to improve the lives of her friends and the poor. She is determined not to marry any of the local, mindless squires but to devote herself to godly work.

Soon, however, she is introduced to Casaubon. Casaubon is an aging, ugly scholar, but Dorothea is attracted by his learning and agrees to marry him in hopes of helping him in his work. Their marriage is unhappy and cold. It is contrasted to Dorothea’s growing relationship with Will Ladislaw, a distant relative of Casaubon. Where Casaubon is cold, Will is passionate. Casaubon senses the kinship between his wife and Will and adds a codicil to his will insisting that if Dorothea and Will marry after his death than Dorothea must give up Casaubon’s house and money.

Shortly thereafter, Casaubon does die, and Dorothea is outraged upon hearing of the codicil. She does not recognize her feelings towards Will as feelings of love. By the end of the novel, however, the two confess their feelings and Dorothea gives up her earthly possesssions to live happily.

The plot developed around Lydgate and Rosamond is of particular medical interest. Lydgate is a new kind of medical practitioner. At the beginning of the nineteenth century, the traditional medical order, consisting of physicians (like modern consultants), surgeons, and apothecaries, was being replaced. New well-schooled general practitioners could perform all these functions.

When Lydgate arrives in Middlemarch with his modern techniques and visions of building a modern hospital for the poor, the medical establishment greet him with jealousy and suspicion. Lydgate’s practice therefore develops very slowly. His marriage to Rosamond, a woman used to a rich lifestyle, quickly depletes his savings.

Facing bankruptcy and the loss of his disappointed wife, Lydgate receives an unexpected loan from Bulstrode, a wealthy landowner. Soon after, Bulstrode is charged with murder and Lydgate is accused of having a hand in it; Middlemarch sees the loan as a payoff. Disgraced, Lydgate cannot fight back. He becomes a doctor who toadies to the wealthy and abandons his revolutionary dreams. He dies at 50.