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 Contents
Preface xi
Letter to the Student xv
How to Interpret Case Citations xvii
About the Author xix
Reviewers xxi

1 Introduction to Medical Law, Ethics, and Bioethics 1

Why Study Law, Ethics, and Bioethics? 3
Medical Law 7
Ethics 9
Models for Examining Ethical Dilemmas 18
What Ethics Is Not 21
Bioethics 22
The Role of Ethics Committees 23
Quality Assurance Programs 23
Medical Etiquette 24

Part i thE LEgaL EnvironmEnt 29

2 The Legal System 29

The Legal System 31
Sources of Law 33
Classification of Laws 36
The Court Systems 44
The Trial Process 46

3 Essentials of the Legal System for Healthcare

Professionals 55
Medical Practice Acts 57
Licensure of the Physician 58
Standard of Care 61 vii
Confidentiality 62
viii Contents

Statute of Limitations 63
Good Samaritan Laws 64
Respondeat Superior 65
Risk Management 67

4 Working in Today’s Healthcare Environment 75

Today’s Healthcare Environment 77
Types of Medical Practice 83
The Ethics of Fee Splitting 86
Medical Specialty Boards 87
Allied Health Professionals 90

Part ii thE hEaLthcarE EnvironmEnt 99

5 The Physician-Patient Relationship 99

Physician’s Rights 101
Physician’s Responsibilities 102
Professional Practice Responsibilities 103
Patients’ Rights 112
Rights of Minors 118
Patients’ Responsibilities 119
Role of the Healthcare Consumer 124

6 Professional Liability and Medical Malpractice 129

Professional Negligence and Medical Malpractice 132
The Tort of Negligence 133
Fraud 138
Office of Inspector General 140
Defense to Malpractice Suits 142
Professional Liability 145
Alternative Dispute Resolution 150
Liability of Other Health Professionals 151
Tort Reform 154
Malpractice Prevention 155

7 Public Duties of the Healthcare Professional 163

Public Health Records and Vital Statistics 165
Controlled Substances Act and Regulations 175
Protection for the Employee and the Environment 178
 Contents ix

8 Workplace Law and Ethics 187

Professionalism in the Workplace 189
Discrimination in the Workplace 190
Privacy and the Workplace 190
Cultural Considerations 191
Religious Considerations 192
Effective Hiring Practices 194
Legal and Illegal Interview Questions 195
Federal Regulations Affecting the Professionals 196
Equal Employment Opportunity and Employment Discrimination 197
Employee Health and Safety 202
Compensation and Benefits Regulations 206
Consumer Protection and Collection Practices 209

9 The Medical Record 219

Purpose of the Medical Record 221
Contents of the Medical Record 222
Ownership of the Medical Record 228
Confidentiality and the Medical Record 228
Retention and Storage of Medical Records 231
Reporting and Disclosure Requirements 234
Use of the Medical Record in Court 234

10 Patient Confidentiality and HIPAA 241

Confidentiality 243
Privacy Act of 1974 245
Health Insurance Portability and Accountability Act (HIPAA) of 1996 245
Ethical Concerns with Information Technology (Informatics) 258

Part iii mEdicaL Ethics 267

11 Ethical and Bioethical Issues in Medicine 267

Early History 269
Ethical Standards and Behavior 270
Codes of Ethics 271
Codes of Ethics for Other Medical Professionals 273
Bioethical Issues 274
Ethical Issues and Personal Choice 279
x Contents

The Ethics of Biomedical Research 279

Human Genome Project 283
Genetic Engineering 284

12 Ethical Issues Relating to Life 295

Fetal Development 297
Assisted or Artificial Conception 298
Contraception 303
Sterilization 304
Abortion 307
Genetic Counseling and Testing 313
Wrongful-Life Suits 317

13 Death and Dying 325

The Dying Process 327
Legal Definition of Death 327
Stages of Dying 337
Quality-Of-Life Issues 338
Use of Medications 338
Hospice Care 339
Palliative Care 340
Viatical Settlements 341
Advance Directives 341
Choices in life and death 342

14 Future Trends in Healthcare 353

Problems in the Current Healthcare System 355
New Advances and Improvement in Healthcare 359
Healthcare Trends and Reform 361
The Ethics of Care under the Affordable Care Act 365

Appendix A. Codes of Ethics 373

Appendix B. Case Citations 377
Glossary 381
Index 391
Preface
T he allied health professional has always been an important member of the
medical team. This team awareness is even more critical in today’s health-
care environment, because the physician no longer practices medicine alone.
Therefore, the text discusses medical law and ethics as it relates to allied healthcare
professionals, as well as the physician’s duties and responsibilities.
Medical Law and Ethics is written in straightforward language that is aimed at
the nonlawyer health professional who must be able to cope with multiple legal and
ethical issues. This text is appropriate for those studying in a college or university who
are working toward careers in the allied health field in a variety of settings, such as
medical offices, hospitals, clinics, laboratories, rehabilitation facilities, and skilled-
nursing facilities. Because most allied healthcare professionals work either with or for
a physician, it is important to understand the physician’s responsibilities and duties
to the patient. Therefore, they are covered in this book. Included are examples of
common legal and ethical issues that affect those working in the healthcare field.
A wide range of pertinent topics are discussed, such as the legal system, professional
liability and medical malpractice, public duties of the physician, the medical record,
and ethical and bioethical issues. There is an in-depth discussion of the regulations
affecting the healthcare professional, including up-to-date information about the
Health Insurance Portability and Accountability Act of 1996 (HIPAA) as well as the
Patient Protection and Affordable Care Act of 2010 (PPACA). The intent is to help
healthcare professionals to better understand our ethical obligation to ourselves, our
patients, and our employers. A new addition to stimulate discussion is the Critical
Thinking Exercise at the end of each chapter.
Many legal cases are sprinkled throughout the text to demonstrate the history
of the law as it pertains to subjects such as patient confidentiality, managed care,
federal regulations affecting the employee, death and dying, and abortion. In some
examples, the cases may seem old, but because we as a country have a legal system
based on case law, these laws are still pertinent today. A legal icon (scales of justice)
appears in the margin to indicate legal case citations.
A special feature called Med Tips provides quick information about law and eth-
ics. These brief scenarios and hints help to maintain interest in this vital subject. Each
chapter includes glossary terms highlighted in bold on first reference, extensive end-
of-chapter exercises, and one actual practice case. The appendices include a sample
of codes of ethics that form a basis for current practice and legal case citations.
This text provides an overview of medical law and ethics. Practicing healthcare
professionals should know the legal requirements in their own jurisdictions.
xi
xii Preface

Finally, many educators have offered thoughtful comments as reviewers of this

text. I am extremely grateful that they have shared their time and experience to help
develop this textbook.

Chapter StruCture
◗ Learning Objectives. These include an overview of the basic knowledge
discussed within the chapter and can be used as a chapter review.
◗ Key Terms. Important vocabulary terms are listed alphabetically at the begin-
ning of each chapter and printed in bold the first time they are defined in the text.
◗ Introduction. Each chapter begins with an introductory statement that reflects
the topic of the chapter.
◗ Review Challenge. A selection of short answer, matching, and multiple-choice
questions are included to test the student’s knowledge of the chapter material.
◗ Case Study. The case studies are based on real-life occurrences and offer
practical application of information discussed within the chapter. These are
included to stimulate and draw upon the student’s critical-thinking skills and
problem-solving ability.
◗ Critical Thinking Exercise. These exercises at the end of each chapter
challenge the student to answer the question “What would you do if …” relating
to many current healthcare and legal dilemmas in today’s environment.
◗ Bibliography. These useful resources provide further information on the topics
included within the chapter.

SpeCial FeatureS
◗ Med Tip. Med Tips are placed at strategic points within the narrative to provide
helpful hints and useful information to stimulate the student’s interest in the topic.
◗ Legal Case Citations. Discipline-specific cases are used throughout the text to
illustrate the topic under discussion. The cases reflect the many medical disciplines,
including that of the physician, that come together in the care of the patient. While
this book is not meant to be a law book, the cases cited in the book are meant to
emphasize the importance of the law for the students.
◗ Points to Ponder. Thought-provoking questions give students an opportunity
to evaluate how they might answer some of the tough, medically related ethical
dilemmas in today’s society. These questions can also be used for critical debate
among students during a class activity.
◗ Discussion Questions. These end-of-chapter questions encourage a review of
the chapter contents.
◗ Put It into Practice. These thought-provoking activities appear at the end of
each chapter. They provide a clinical correlation with the topics discussed in the
chapter and stimulate the student’s own contemplation of legal and ethical issues
that are apparent in everyday life.
 Preface xiii

◗ Web Hunt. This end-of-chapter Internet activity encourages the student to access
the multitude of medical resources available through this medium.
◗ Appendices. Codes of Ethics are included in Appendix A; useful healthcare
websites are listed online; the case citations used throughout the book are listed in
Appendix B.
◗ Additional Examination Review Questions. These are included in the
Instructor’s Resource Manual.

Visit our new Resource Page to accompany Medical Law and Ethics, 5th Ed.
(http://www.pearsonhighered.com/healthprofessionsresources/) for a collection
of downloadable quizzes, and reference materials.

aCknowledgmentS
This book would not have been possible without the assistance and guidance of many
people. I am grateful to the editorial and production staffs at Pearson Education for
their skill and patience with this project. I thank, Marlene Pratt Acquisitions Editor
and, Faye Gemmellaro Program Manager, for their leadership and guidance with this
project, and whose courtesy and thoroughness are greatly appreciated; Pat Walsh,
whose calm presence is always available.
This page intentionally left blank
Letter to the
Student
I t’s a natural tendency to read some of the case examples in this book and think that
they must be fictional as no well-trained healthcare professional would ever be so
negligent. However, the short ethics cases at the beginning of each chapter, with the
exception of the historical cases, are indeed real. All of these cases are drawn from
the author’s experience.
Throughout the book there are numerous examples of actual legal cases that usu-
ally resulted in suffering for patients, as well as for physicians and other healthcare
professionals. The cases discussed are not meant to focus on particular healthcare
disciplines, nor to exclude any disciplines. And these cases are not meant to frighten
but, rather, to alert all of us to the potential risks to patients when healthcare profes-
sionals are not diligent about the care they provide. Do not memorize the case cita-
tions, but rather try to understand the circumstances and why the case was included
in this book.
I have a great respect for all the disciplines mentioned in this book. My intent is
to prepare students to promote good patient care, as well as to protect themselves
and their employers from lawsuits.
For a successful start to your study of medical law and ethics, consider following
the ABCs of classroom success: Actively participate, Benefit from the experience,
and Commit to learning. It is necessary for you to attend class to truly benefit from
your ethics education. So much happens in the classroom—especially the interaction
between you and your classmates. The discussion portion of an ethics class is one of
the most important components. You must be present to contribute. The text serves as
an information source and as the first step in your education—the dynamics of class-
room interaction between you, your instructor, and the other students is critical for
success in learning.

Actively participate when you attend class. It is necessary to absorb what

takes place during the class session. Listen carefully to what your instructor and
fellow students say. If you don’t share your ideas, experiences, and questions, then
the rest of the class is losing what you have to offer. The dialogue about ethics
that you have with your instructor and fellow classmates can be one of the most
meaningful learning experiences.

xv
xvi Letter to the Student

Benefit from the experience and ideas of your peers (classmates). Listen to the
opinions of others during class discussions. Pay particular attention to the opinions
that differ from your own. As a member of the healthcare team, you will frequently
hear opinions that differ from your own—both from your coworkers and your
patients. You do not have to change your opinions or beliefs, but try to keep an
open mind to the opinions of others.
Commit to learning by carefully reading and analyzing the textbook material.
Look for new information and also for discussion points that both agree and dis-
agree with your own perspective. Take this course seriously so that it is not a waste
of your time. In fact, your ethics class can be one of the most important classes that
you take! Communicate what you have learned. Your perspective is important for
others to hear. Use your time wisely in class, share your ideas, and listen to the
thoughts of others.

The law is dynamic and often is revised as changes take place in society. For
example, two of the newest laws affecting healthcare are the Healthcare Insurance
Portability and Accountability Act (HIPPA) of 1996 and the Patient Protection and
Affordable Care Act of 2010 (PPACA), also known as the Affordable Care Act. They
have both had an impact on healthcare organizations as well as physician’s offices.
This textbook is not meant to be a study of the law, but rather to introduce students
to the impact that law and ethics have on their professional lives.
Finally, our goal as teachers is to help our students learn how to judge themselves
and their actions. Because you won’t have us with you in the workplace, we want
you to be able to evaluate your own actions in light of their ethical and legal impact
on others.
How to Interpret
Case Citations
S elected legal cases are used in this textbook to illustrate various legal principles.
At the end of each case summary is a citation, such as Moon Lake Convalescent
Center v. Margolis, 433 N.E.2d 956 (Ill. App. Ct. 1989). This citation, similar to a
street address, tells you where you can find this case among the many sets of reported
cases (called reporters) in the library. Most case citations end with information in pa-
rentheses, such as (Ill. App. Ct. 1989), which tells you what court (the Illinois Appellate
Court) decided the case and the year (1989) of the decision, but you do not need that
information when you are simply trying to locate a particular case in the library. The
small v. between the litigants’ names stands for “versus.” A case citation consists of
◗ The italicized case name—usually the name of the plaintiff and the defendant. In
our example, Moon Lake Convalescent Center (defendant) and Margolis (plaintiff).
◗ The name of the reporter(s) where the case is published ( Northeast Reporter,
2d series).
◗ The volume number(s) of the reporter(s) where the case is published (433).
◗ The page number of the volume where the case begins (956).
◗ The year the case was decided (1989).
◗ For federal Court of Appeals cases, a designation of the circuit; for federal District
Court cases, the state and judicial district where the court is located; for state
cases, an indication of the state if it is not apparent from the name of the reporter
(Illinois Appellate Court).

Therefore, our example case between Moon Lake Convalescent Center and
Margolis is found in volume 433 of the Northeast Reporter, 2d series, on page 956.
Abbreviations for other reporters (books) are:

A (Atlantic Reporter)
P (Pacific Reporter)
U.S. (United States Reporter)
F.Supp. (Federal Supplement)
F (Federal Reporter)
NE (Northeast Reporter)
NW (Northwest Reporter)
NYS (New York Supplement)
So (Southern Reporter)
xvii
SW (Southwestern Reporter)
xviii How to Interpret Case Citations

Most reporters have been published in two or more series, such as 2d, meaning
second series. The student should not be concerned with memorizing the names of the
reporters. The abbreviations for them are found at the beginning of most of the legal
research publications that we use. As you do research within your own state, you will
become familiar with the abbreviations that are most commonly used. Legal research
can be done through a law library or via the Internet from Lexis-Nexis, which is a sub-
scription service used by law firms and libraries.
About the Author
B onnie F. Fremgen, Ph.D., is a former associate dean of the Allied Health Program
at Robert Morris College and was vice president of a hospital in suburban
Chicago. She has taught medical law and ethics courses as well as clinical and
administrative topics. She has broad interests and experiences in the healthcare field,
including hospitals, nursing homes, and physicians’ offices. She currently has two
patents on a unique circulation-assisting wheelchair.
Dr. Fremgen holds a nursing degree as well as a master’s in healthcare admin-
istration. She received her Ph.D. from the College of Education at the University of
Illinois. She has performed postdoctoral studies in medical law at Loyola University
Law School in Chicago.
Dr. Fremgen has taught ethics at the University of Notre Dame, South Bend,
Indiana; University of Detroit, Detroit, Michigan; and Saint Xavier University,
Chicago, Illinois.

xix
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more strenuous position, in which I cannot sink into the self-
absorption and laziness I was in danger of before. The whole history
is something like a miracle-legend. But instead of any former
affection being displaced in my mind, I seem to have recovered the
loving sympathy that I was in danger of losing. I mean, that I had
been conscious of a certain drying-up of tenderness in me, and that
now the spring seems to have risen again. Who could take your
place within me or make me amends for the loss of you? And yet I
should not take it bitterly if you felt some alienation from me. Such
alienation is very natural where a friend does not fulfil expectations
of long standing.
We have already been ten days at Venice, but we hope to remain as
long again, not fearing the heat, which has hitherto been only a
false alarm in the minds of English travellers. If you could find time
to send me word how you all are—yourself, Dr. Congreve after his
holiday, and Emily, with all her cares about removal—a letter sent to
the Poste Restante here would reach me, even if we had left before
the next ten days were over. We shall hardly be at Witley before the
middle of July: but the sense of neighborhood to you at Witley is
sadly ended now.

We thought too little of the heat, and rather laughed at English

people's dread of the sun. But the mode of life at Venice has its
peculiar dangers. It is one thing to enjoy heat when leading an
active life, getting plenty of exercise in riding or rowing in the
evenings; it is another thing to spend all one's days in a gondola
—a delicious, dreamy existence—going from one church to
another—from palaces to picture-galleries—sight-seeing of the
most exhaustively interesting kind—traversing constantly the
piccoli rei, which are nothing more than drains, and with
bedroom-windows always open on the great drain of the Grand
Canal. The effect of this continual bad air, and the complete and
sudden deprivation of all bodily exercise, made me thoroughly
ill. As soon as I could be moved we left Venice, on the 23d of
June, and went to Innspruck, where we stayed for a week, and
 in the change to the pure, sweet, mountain air I soon regained
strength.

I was made very glad by Gertrude's letter, which

assured me that Witley had been enjoyed by you Letter to Charles
L. Lewes, 7th July,
and the little ones. We stayed six days at 1880, from
Innspruck, finding it more and more beautiful Stuttgart.
under the sunshine which had been wanting to it
during our first two days. Then we went on to Munich, and
yesterday we arrived here, as a temporary resting-place on our way
to Wildbad, which, we hope, will put the finishing-touch to J.'s
recovery of his usual health.
I wish I had been able to let you know in time that you could have
remained a little longer at Witley, as I think we shall hardly be at
home before the 20th if we find Wildbad what we want. Your Mutter
is marvellously well and strong. It seems more natural to her to have
anxiety than to be free from it. Let us hope that she will not run
down like a jelly-fish now that her anxiety is over.
I received your welcome letter yesterday morning,
and felt inclined to answer it the next minute. J. is Letter to Charles
L. Lewes, 13th
quite well again, but is inclined to linger a little in July, 1880, from
the sweet air of the Schwarzwald, which comes to Wildbad.
one on gently stirred wings, laden with the scent of
the pine forests. We mean to drive from here to Baden, which is
within easy distance.
Yesterday we sallied forth for a walk over the mountain, to a place
where we could rest and lunch, returning in the afternoon. The sky
was brilliant. But in half an hour the clouds gathered and threatened
a storm. We were prudent enough to turn back, and by the time we
were in the hotel again the thunder was rolling and the rain pouring
down. This continued till about two o'clock, and then again the sky
became clear. I never saw so incalculable a state of weather as we
have in this valley. One quarter of an hour the blue sky is only
flecked by lightest cirrus clouds, the next it is almost hidden by dark
rain clouds. But we are going to start on our promised expedition
this morning, the sunshine flattering us that it is quite confirmed.
I think you had better address your next letter Poste Restante,
Strasburg, as I am uncertain how long we shall rest at Baden.

Left Wildbad on the 17th July, and had a delightful drive

through the Black Forest by Herrenalb to Baden, and thence by
Strasburg, Metz, Luxemburg, and Brussels, arriving at Witley on
Monday the 26th of July.

We arrived here in all safety last Monday, and if I

had not had your welcome little note this morning I Letter to Madame
Bodichon, 1st
think I should soon have written to you without Aug. 1880.
any such extra stimulus.
Mr. Cross had a sharp but brief attack at Venice, due to the
unsanitary influences of that wondrous city in the later weeks of
June. We stayed a little too long there, with a continuous sirocco
blowing, and bad smells under the windows of the hotel; and these
conditions found him a little below par from long protracted anxiety
before our marriage. But ever since we left Venice (on the 23d of
June) he has been getting strong again, and we have enjoyed a
leisurely journey through Germany in constant warmth and
sunshine, save for an occasional thunderstorm. The climate in this
beloved country of ours is a sad exchange, and makes one think of a
second bad harvest, with all its consequences. Still, it is a delight to
be at home and enjoy perfect stillness, after the noisiness of foreign
bells and foreign voices indoors and out. It would be very pretty to
pay you a visit next April, if we are all alive, and I think Mr. Cross
would like it very much. He sends you, hoping you will accept them,
his best remembrances, which have been kept up by our often
talking about you. I have been amazingly well through all the
exertion of our travels, and in the latter half of the time have done a
great deal of walking.
How sweet of you to write me a little welcome as
soon as you knew that I was at home again. Letter to Mrs.
Peter Taylor, 2d
Aug. 1880.
Yes, we are both well now, and glad to be at home
again, though the change of climate is not of the exhilarating sort.
One is so sorry for all the holiday-makers, whose best enjoyment of
these three days would have been in the clear air and sunshine.
Do not reproach me for not telling you of my marriage beforehand.
It is difficult to speak of what surprises ourselves, and the decision
was sudden, though not the friendship which led to the decision.
My heart thoroughly responds to your remembrance of our long—
our thirty-years' relation to each other. Let me tell you this once
what I have said to others—that I value you as one of the purest-
minded, gentlest-hearted women I have ever known, and where
such a feeling exists, friendship can live without much aid from sight.
We shall probably not be in town again till the beginning of
November. Our address then will be 4 Cheyne Walk, Chelsea, where
we shall have an outlook on the river and meadows beyond. Just
now we have the prospect of going on family visits to married
sisters, which prevents us from feeling quite settled.
I expected your letter, and expected, too, just the
sort of letter I have received, telling me everything Letter to Charles
L. Lewes, 12th
delightfully. I can follow you everywhere in your Aug. 1880.
journeying except to Ober Wesel. I hope you will
have enjoyed St. Blasien and some of the walks there consecrated
by the beloved Pater's footsteps. We reversed your drive and went
to Freiburg, so that I can enter into your enjoyment of the
Höllenthal. I am glad that your weather has been temperate. Here
we have now had four sunny and really hot days, and this morning
promises to be the fifth. That is consolatory as to the harvest, and is
very agreeable as to our private life. The last two evenings we have
walked in the garden after eight o'clock—the first time by starlight,
the second under a vapory sky, with the red moon setting. The air
was perfectly still and warm, and I felt no need of extra clothing.
Our life has had no more important events than calls from neighbors
and our calls in return. To-morrow we pay our visit to the Druces at
Sevenoaks, where, you may remember, Mr. Druce has built a
beautiful house. At the beginning of September we are to visit Mr.
and Mrs. Otter at Ranby, and after that we shall go to Six-Mile
Bottom for a day or two. Then our wanderings will be over.
I went to the Priory the other day, and found a treatise on Blood
Pressure, by Dr. Roy, which he had sent me there, and which he has
published as the "George Henry Lewes Student." I imagine that he
has come to pursue his studies in England, as he intended to do.
Delbeuf's article on the last volume of the "Problems" (in the Belgian
Athenæum) is very nicely done. He has read the book.
I am pretty well, but find myself more languid than I was when
abroad. I think the cause is perhaps the moisture of the climate.
There is something languorous in this climate, or, rather, in its
effects. J. gets a little better every day, and so each day is more
enjoyable.
We have just come home after paying family visits
in Lincolnshire and Cambridgeshire, else I should Letter to Mrs.
Burne-Jones, 9th
have answered your letter earlier. The former one Sept. 1880.
reached me in Venice, when I was in great trouble
on account of Mr. Cross's illness. I had had reason to believe that my
letters, ordered to be posted on the 5th of May, had not been
delivered; so I asked Charles to inquire about the letter I wrote to
you—not because it demanded an answer, but because I wished you
to know that I had written.
I am so glad to know that you have been enjoying our brief English
summer. The good harvest makes the country everywhere cheerful,
and we have been in great, even districts where the fields, full of
sheaves or studded with ricks, stretch wide as a prairie. Now, we
hope not to leave this place again till November, when we intend to
go to Chelsea for the winter and earliest spring.
I almost envy you the opportunity of seeing Wombwell's Menagerie.
I suppose I got more delight out of that itinerant institution when I
was nine or ten years old than I have ever got out of the Zoological
Gardens. The smells and the sawdust mingled themselves with my
rapture. Everything was good.
It was very dear of you to write to me before you finished your
holiday. My love attends you all.
Your letter this morning is a welcome assurance
about you. We have been away in Lincolnshire and Letter to Madame
Bodichon, 14th
Cambridgeshire, paying visits to the Otters and the Sept. 1880.
Halls. The weather, which is now broken, was
glorious through all our wandering, which we made very interesting
by pausing to see Ely, Peterborough, and Lincoln cathedrals. The
Otters have a very pretty, happy household. He is a country
gentleman now, acting as a magistrate, and glancing towards
Parliament. But he keeps up his reading, and is delightful to talk to.
Emily looks very pretty in her matronly position, with three little
children. The Halls, too, are very pleasant to behold in their home
life. He has done wonders in building nice cottages and schools, and
sinking wells where they were wanted, and founding a co-operative
store—and, in general, doing whatever opportunity allows towards
slowly improving this confused world. We saw (at Six-Mile Bottom)
Mr. and Mrs. Sidgwick. Perhaps you know that they have had, and
have, the admirable public spirit to let their house and arrange to
live for a year in the new Newnham House, in order to facilitate
matters for the double institution.
We are very well. Mr. Cross gets stronger and brighter every day. We
often mention you, because you are associated with so many of my
memories.
Our only bugbear—it is a very little one—is the having to make
preliminary arrangements towards settling ourselves in the new
house (4 Cheyne Walk). It is a quaint house; and a Mr. Armitage of
Manchester, of whom you may have heard, has been superintending
the decoration and furnishing, but not to the exclusion of old things,
which we must carry and stow, especially wallings of books. I am
become so lazy that I shrink from all such practical work.
I have been and am suffering under an attack of a
comparatively mild sort, but I expect to be well in Letter to Charles
L. Lewes, 23d
two or three days, and am just going to drive to Sept. 1880.
Godalming to meet my husband. Hence I write this
hurriedly. We should like to see you and Gertrude from Saturday to
Monday some week next month if it would be pleasant to you.

This attack was a recurrence of the renal disorder of the

previous year. On the 29th September we went for ten days to
Brighton as the most accessible place for a bracing change. The
first effects of the sea breezes were encouraging, but the
improvement was not maintained. Shortly after our return to
Witley Dr. Andrew Clark,[47] "the beloved physician," came
down to consult with Mr. Parsons of Godalming—on 22d
October. From that time there was gradual but slow
improvement, and, during November, a decided recovery of
strength. But an English autumn was not favorable to the
invalid. Her sensibility to climatic influences was extreme. It will
have been noticed in the preceding letters how constantly
change of air and scene was required. I had never seen my wife
out of England, previous to our marriage, except the first time
at Rome, when she was suffering. My general impression,
therefore, had been that her health was always very low, and
that she was almost constantly ailing. Moreover, I had been with
her very frequently during her long, severe illness at Witley in
1879. I was the more surprised, after our marriage, to find that
from the day she set her foot on Continental soil till the day she
returned to Witley she was never ill—never even unwell. She
began at once to look many years younger. During the eleven
years of our acquaintance I had never seen her so strong in
health. The greater dryness and lightness of the atmosphere
seemed to have a magical effect. At Paris we spent our
mornings at the Louvre or the Luxembourg, looking at pictures
or sculpture, or seeing other sights—always fatiguing work. In
the afternoons we took long walks in the Bois, and very often
went to the theatre in the evening. Reading and writing filled in
all the interstices of time; yet there was no consciousness of
fatigue. And we had the same experience at all the places we
stayed at in Italy. On our way home she was able to take a
great deal of walking exercise at Wildbad and Baden. Decrease
of physical strength coincided exactly with the time of our
return to the damper climate of England. The specific form of
illness did not declare itself until two months later, but her
health was never again the same as it had been on the
Continent. Towards the middle of October she was obliged to
keep her bed, but without restriction as to amount of reading
and talking, which she was always able to enjoy, except in
moments of acute pain.
During her illness I read aloud, among other books, Comte's
"Discours Préliminaire," translated by Dr. Bridges. This volume
was one of her especial favorites, and she delighted in making
me acquainted with it. For all Comte's writing she had a feeling
of high admiration, intense interest, and very deep sympathy. I
do not think I ever heard her speak of any writer with a more
grateful sense of obligation for enlightenment. Her great debt to
him was always thankfully acknowledged. But the appreciation
was thoroughly selective, so far as I was able to judge. Parts of
his teaching were accepted and other parts rejected. Her
attitude towards him, as the founder of a new religion, may be
gathered from the references and allusions in the foregoing
correspondence, and from the fact that for many years, and up
to the time of her death, she subscribed to the Comtist Fund,
but never, so far as I am aware, more directly associated herself
with the members of the Positivist Church. It was a limited
adherence.
We generally began our reading at Witley with some chapters of
the Bible, which was a very precious and sacred book to her, not
only from early associations, but also from the profound
conviction of its importance in the development of the religious
life of man. She particularly enjoyed reading aloud some of the
finest chapters of Isaiah, Jeremiah, and St. Paul's Epistles. With
a naturally rich, deep voice, rendered completely flexible by
constant practice; with the keenest perception of the
requirements of emphasis, and with the most subtile
modulations of tone, her reading threw a glamour over
indifferent writing, and gave to the greatest writing fresh
meanings and beauty. The Bible and our elder English poets
best suited the organ-like tones of her voice, which required, for
their full effect, a certain solemnity and majesty of rhythm. Her
reading of Milton was especially fine; and I shall never forget
four great lines of the "Samson Agonistes" to which it did
perfect justice—

"But what more oft in nations grown corrupt,

And by their vices brought to servitude,
Than to love bondage more than liberty,
Bondage with ease than strenuous liberty."

The delighted conviction of justice in the thought—the sense of

perfect accord between thought, language, and rhythm—
stimulated the voice of the reader to find the exactly right tone.
Such reading requires for its perfection a rare union of
intellectual, moral, and physical qualities. It cannot be imitated.
It is an art, like singing—a personal possession that dies with
the possessor, and leaves nothing behind except a memory.
Immediately before her illness we had read, together, the first
part of "Faust." Reading the poem in the original with such an
interpreter was the opening of a new world to me. Nothing in all
literature moved her more than the pathetic situation and the
whole character of Gretchen. It touched her more than anything
in Shakespeare. During the time that we were reading the
"Faust" we were also constantly reading, together, Shakespeare,
Milton, and Wordsworth: some of Scott's novels and Lamb's
essays too, in which she greatly delighted. For graver study we
read through Professor Sayce's "Introduction to the Science of
Language." Philology was a subject in which she was most
deeply interested; and this was my first experience of what
seemed to me a limitless persistency in application. I had
noticed the persistency before, while looking at pictures, or
while hearing her play difficult music; for it was characteristic of
her nature that she took just as great pains to play her very
best to a single unlearned listener as most performers would do
to a room full of critical cognoscenti. Professor Sayce's book was
the first which we had read together requiring very sustained
attention ("The Divina Commedia" we had read in very short
bits at a time), and it revealed to me more clearly the depth of
George Eliot's mental concentration. Continuous thought did not
fatigue her. She could keep her mind on the stretch hour after
hour: the body might give way, but the brain remained
unwearied.
Her memory held securely her great stores of reading. Even of
light books her recollections were always crisp, definite, and
vivid. On our way home from Venice, after my illness, we were
reading French novels of Cherbuliez, Alphonse Daudet, Gustave
Droz, George Sand. Most of these books she had read years
before, and I was astonished to find what clear-cut, accurate
impressions had been retained, not only of all the principal
characters, but also of all the subsidiary personages—even their
names were generally remembered. But, on the other hand, her
verbal memory was not always to be depended on. She never
could trust herself to write a quotation without verifying it.
In foreign languages George Eliot had an experience more
unusual among women than among men. With a complete
literary and scholarly knowledge of French, German, Italian, and
Spanish, she spoke all four languages with difficulty, though
accurately and grammatically; but the mimetic power of
catching intonation and accent was wanting. Greek and Latin
she could read with thorough delight to herself; and Hebrew
was a favorite study to the end of her life. In her younger days,
especially at Geneva, inspired by Professor de la Rive's lectures,
she had been greatly interested in mathematical studies. At one
time she applied herself heartily and with keen enjoyment to
geometry, and she thought that she might have attained to
some excellence in that branch if she had been able to pursue
it. In later days the map of the heavens lay constantly on her
table at Witley, and she longed for deeper astronomical
knowledge. She had a passion for the stars; and one of the
things to which we looked forward on returning to London was
a possible visit to Greenwich Observatory, as she had never
looked through a great telescope of the first class. Her
knowledge of wild-flowers gave a fresh interest each day to our
walks in the Surrey lanes, as every hedgerow is full of wonders
—to "those who know;" but she would, I think, have disclaimed
for herself real botanical knowledge, except of an elementary
sort.
This wide and varied culture was accompanied with an
unaffected distrust of her own knowledge, with the sense of
how little she really knew, compared with what it was possible
for her to have known, in the world. Her standard was always
abnormally high—it was the standard of an expert; and she
believed in the aphorism that to know any subject well we must
know the details of it.
During our short married life our time was so much divided
between travelling and illness that George Eliot wrote very little,
so that I have but slight personal experience of how the creative
effort affected her. But she told me that, in all that she
considered her best writing, there was a "not herself," which
took possession of her, and that she felt her own personality to
be merely the instrument through which this spirit, as it were,
was acting. Particularly she dwelt on this in regard to the scene
in "Middlemarch" between Dorothea and Rosamond, saying
that, although she always knew they had, sooner or later, to
come together, she kept the idea resolutely out of her mind until
Dorothea was in Rosamond's drawing-room. Then, abandoning
herself to the inspiration of the moment, she wrote the whole
scene exactly as it stands, without alteration or erasure, in an
intense state of excitement and agitation, feeling herself entirely
possessed by the feelings of the two women. Of all the
characters she had attempted she found Rosamond's the most
difficult to sustain. With this sense of "possession" it is easy to
imagine what the cost to the author must have been of writing
books, each of which has its tragedy. We have seen the
suffering alluded to in the letters on the "Mill on the Floss,"
"Felix Holt," and "Romola."
For those who would know the length and the breadth of
George Eliot's intellectual capacity she has written her books.
Here I am only putting down some of my own personal
impressions or recollections, which must be taken for what they
are worth. In doing this I should like to dwell on the catholicity
of her judgment. Singularly free from the spirit of detraction,
either in respect of her contemporaries or her predecessors, she
was always anxious to see the best and the most noble qualities
of human beings or of books, in cases where she felt some
general sympathy notwithstanding particular disagreements.
And it was this wide sympathy, this understanding of so many
points of view, that gained for her the passionate devotion not
only of personal friends, but also of literary admirers, from the
most widely sundered sections of society. Probably few people
have ever received so many intimate confidences from
confidants of such diverse habits of thought.
This many-sidedness, however, makes it exceedingly difficult to
ascertain, either from her books or from the closest personal
intimacy, what her exact relation was to any existing religious
creed or to any political party. Yet George Eliot's was
emphatically a religious mind. My own impression is that her
whole soul was so imbued with, and her imagination was so
fired by, the scientific spirit of the age—by the constant rapid
development of ideas in the Western world—that she could not
conceive that there was, as yet, any religious formula sufficient
nor any known political system likely to be final. She had great
hope for the future, in the improvement of human nature by the
gradual development of the affections and the sympathetic
emotions, and "by the slow, stupendous teaching of the world's
events," rather than by means of legislative enactments. Party
measures and party men afforded her no great interest.
Representative government, by numerical majorities, did not
appeal to her as the last word of political wisdom. Generally
speaking, she had little patience with talk about practical
politics, which seemed to her under our present system to be
too often very unpractically handled by ignorant amateurs. The
amateur was always a "stone of stumbling, and a rock of
offence." Her wrath used often to be roused, in late years, by
the increased bitterness in the language of parties, and by the
growing habit of attributing, for political effect, the most
shameful motives to distinguished statesmen.
She was keenly anxious to redress injustices to women, and to
raise their general status in the community. This, she thought,
could best be effected by women improving their work—ceasing
to be amateurs. But it was one of the most distinctly marked
traits in her character that she particularly disliked everything
generally associated with the idea of a "masculine woman." She
was, and as a woman she wished to be, above all things,
feminine—"so delicate with her needle, and an admirable
musician." She was proud, too, of being an excellent
housekeeper—an excellence attained from knowing how things
ought to be done, from her early training, and from an inborn
habit of extreme orderliness. Nothing offended her more than
the idea that because a woman had exceptional intellectual
powers therefore it was right that she should absolve herself, or
be absolved, from her ordinary household duties.
It will have been seen from the letters that George Eliot was
deeply interested in the higher education of women, and that
she was among the earliest contributors to Girton College. After
meeting Mr. and Mrs. Henry Sidgwick, in September, 1880,
when they had gone to reside at the new hall of Newnham
College for a time, she was anxious to be associated in that
work also, but she did not live to carry out the plan herself. The
danger she was alive to in the system of collegiate education
was the possible weakening of the bonds of family affection and
family duties. In her view, the family life holds the roots of all
that is best in our mortal lot; and she always felt that it is far
too ruthlessly sacrificed in the case of English men by their
public school and university education, and that much more is
such a result to be deprecated in the case of women. But, the
absolute good being unattainable in our mixed condition of
things, those women especially who are obliged to earn their
own living must do their best with the opportunities at their
command, as "they cannot live with posterity," when a more
perfect system may prevail. Therefore, George Eliot wished
God-speed to the women's colleges. It was often in her mind
and on her lips that the only worthy end of all learning, of all
science, of all life, in fact, is, that human beings should love one
another better. Culture merely for culture's sake can never be
anything but a sapless root, capable of producing at best a
shrivelled branch.
In her general attitude towards life George Eliot was neither
optimist nor pessimist. She held to the middle term, which she
invented for herself, of "meliorist." She was cheered by the hope
and by the belief in gradual improvement of the mass; for in her
view each individual must find the better part of happiness in
helping another. She often thought it wisest not to raise too
ambitious an ideal, especially for young people, but to impress
on ordinary natures the immense possibilities of making a small
home circle brighter and better. Few are born to do the great
work of the world, but all are born to this. And to the natures
capable of the larger effort the field of usefulness will constantly
widen.
In her personal bearing George Eliot was seldom moved by the
hurry which mars all dignity in action. Her commanding brows
and deep, penetrating eyes were seconded by the sweet,
restrained, impressive speech, which claimed something like an
awed attention from strangers. But to those very near to her
there was another side of her nature, scarcely suspected by
outside friends and acquaintances. No one could be more
capable of enjoying and of communicating genuine, loving,
hearty, uncontrollable laughter. It was a deep-seated wish,
expressed in the poem of "Agatha"—"I would have young things
merry." And I remember, many years ago, at the time of our
first acquaintance, how deeply it pained her when, in reply to a
direct question, I was obliged to admit that, with all my
admiration for her books, I found them, on the whole,
profoundly sad. But sadness was certainly not the note of her
intimate converse. For she had the distinctively feminine
qualities which lend a rhythm to the movement of life. The quick
sympathy that understands without words; the capacity for
creating a complete atmosphere of loving interest; the
detachment from outside influences; the delight in everything
worthy—even the smallest thing—for its own sake; the
readiness to receive as well as to give impressions; the
disciplined mental habit which can hold in check and conquer
the natural egoism of a massive, powerful personality; the
versatility of mind; the varied accomplishments—these are
characteristics to be found more highly developed among gifted
women than among gifted men. Add to these the crowning gift
 of genius, and, in such companionship, we may possess the
world without belonging to it.
The November days had come now—cold and clear. My wife was
able again to enjoy the daily drives and walks on which she was
very dependent for health. The letters continue.

Since I wrote to you I have been much more ill,

and have only, during the last few days, begun to Letter to Mrs.
Congreve, 3d Nov.
feel myself recovering strength. But I have been 1880.
cared for with something much better than angelic
tenderness. The fine, clear air, if it lasts, will induce us to linger in
the country; and, indeed, I am not yet quite fit to move; for, though
I appear to be quite cured of my main ailment, half my bodily self
has vanished. We are having deliciously clear days here, and I get
out for short drives and walks. I really have nothing to complain of
now except a little lack of strength. I play on the piano again, and
walk with perfect ease. There is a long chapter about myself!
Three weeks ago I had a rather troublesome
attack, but I am getting well now, though still Letter to Madame
Bodichon, 7th
reduced and comparatively weak. We shall Nov. 1880.
probably linger here till near the end of the month,
for the autumnal landscape is very beautiful, and I am not yet quite
fit for the exertion of moving. It is a comfort to think that you can be
very snug through the winter in your nice house. What a pity we are
not within an easy driving distance from you!
Mr. Hall is here to-day. He gave a lecture on Leclaire, the house-
painter in Paris who initiated an excellent plan of co-operative
sharing for his workmen. It has been printed, and when I have
another copy I will send it you. Leclaire is mentioned by John S. Mill
in the notes to his "Political Economy," but had not been otherwise
taken much notice of. Still, you may know all about him.
Thanks for your loving remembrance of me. We
have been kept in the country by two sufficient Letter to Mrs.
Burne-Jones, 18th
causes: I have been ill, and the house at Cheyne Nov. 1880.
Walk has not been ready to receive us. I suppose
we shall not be there till the end of the month instead of the
beginning. One of the good things I look forward to is the sight of
your dear face again. You will see little more than half of me, for
nearly half has been consumed. But I have been nursed with
supreme tenderness, and am daily gaining some strength. Much love
to both.
We are lingering here for three reasons: the beauty
of the weather, the unreadiness of the house, and Letter to Charles
L. Lewes, 23d
my unfitness to bear the hurry of moving. I am Nov. 1880.
getting better, but have not yet been able to bear
much exertion.
Thanks for your pretty letter. I do not think I shall have many returns
of Novembers, but there is every prospect that such as remain to me
will be as happy as they can be made by the devoted tenderness
which watches over me. Your years will probably be many, and it is
cheering to me to think that you have many springs of happiness in
your lot that are likely to grow fuller with advancing time.
I have thought of you all the more because I have
not even heard anything of you for several months. Letter to Mrs.
Bray, 28th Nov.
You will wonder less why I have not written, as a 1880.
consequence of those thoughts, when I tell you
that I have been ill, and not allowed to do anything but indulge
myself and receive indulgence. I am very well now, and am every
day consciously gathering strength, so that, if I could like giving
trouble, I should look back on my illness as a great opportunity of
enjoying the tenderest watching and nursing. I kept my bed only
about a week, and have always been equal, except at short
intervals, to much reading and talking, so that there is no fair cause
for any grumbling on my part. It has not been so bad an illness as
that of last summer. You see we are not yet at Cheyne Walk, but we
are to be settled there by the end of next week. I have had no
trouble, but have remained here on my cushions while Mr. Cross has
gone early for several mornings running to superintend the removal.
It is difficult to give you materials for imagining my "world." Think of
me as surrounded and cherished by family love; by brothers and
sisters whose characters are admirable to me, and who have for
years been my friends. But there is no excessive visiting among us,
and the life of my own hearth is chiefly that of dual companionship.
If it is any good for me that my life has been prolonged till now, I
believe it is owing to this miraculous affection which has chosen to
watch over me.
Dec. 3.—Came to 4 Cheyne Walk.
Journal, 1880.
Dec. 4.—Went to Popular Concert at St. James's
Hall. Heard Madame Neruda, Piatti, and Miss Zimmermann.
Only on Friday evening did we get into this new
house, and I had deferred writing to you till I could Letter to Mrs.
Congreve, 6th
say "Come and see me." I can say so now, but on Dec. 1880.
reflection I have come to the conclusion that you
would like yourself to fix a time beforehand, the journey here being
rather long. Perhaps you will like to choose a day on which you could
go to Emily also, her house being less formidably distant—across the
park and down Sloane Street would be an easy way to us. This week
we shall be much engaged in household matters, such as the
reduction to order of the chaos which still reigns in certain places
least obvious to visitors, and the procuring of small objects, either
necessary or desirable. But after this week I shall be most glad if
you and Dr. Congreve will come to see us just as and when you
would find the least inconvenience in doing so—either at lunch-time
(half-past one) or at a later hour.
I find myself in a new climate here—the London air and this
particular house being so warm compared with Witley. I hope that
you too find the air mild, for I know that suits you best.

Dr. and Mrs. Congreve paid their promised visit the week after
this letter was written; and Madame Belloc lunched with us the
following day. Order was beginning to reign in the new house.
The books had all been arranged as nearly as possible in the
same order that they had occupied at the Priory, Mr.
Radermacher of the Pantechnicon having given his personal
attention to this arrangement of some thousands of volumes,
for which George Eliot was particularly grateful. Notwithstanding
all this care, however, there were many unforeseen details of
furnishing still to be completed, which caused a considerable
expenditure of time. We continued reading aloud Max Müller's
"Lectures on the Science of Language," and Duffield's
translation of "Don Quixote;" we were also reading "Hermann
and Dorothea," Tennyson's last volume of poems, just
published, and Mr. Frederic Myers's volume on Wordsworth. In
the evenings we had always a little feast of music, and were
becoming in every way reconciled to town life, notwithstanding
the loss of country quiet, light, and beauty. On the afternoon of
Friday, the 17th December, we went to see the "Agamemnon"
performed in Greek by Oxford undergraduates. The
representation was a great enjoyment—an exciting stimulus—
and my wife proposed that during the winter we should read
together some of the great Greek dramas. The following
afternoon we went to the Saturday Popular Concert at St.
James's Hall. It was a cold day. The air in the hall was
overheated, and George Eliot allowed a fur cloak which she
wore to slip from her shoulders. I was conscious of a draught,
and was afraid of it for her, as she was very sensitive to cold. I
begged her to resume the cloak, but, smiling, she whispered
that the room was really too hot. In the evening she played
through several of the pieces that we had heard at the concert,
with all her accustomed enjoyment of the piano, and with a
touch as true and as delicate as ever. On Sunday there was very
slight trouble in the throat, but not sufficient to prevent her
from coming down-stairs to breakfast as usual. In the afternoon
she was well enough to receive visits from Mr. Herbert Spencer
and one or two other friends. Afterwards she began the
 following letter to Mrs. Strachey. It was left unfinished in her
writing-case, and is printed as it stands.

I have been thinking so much of Lady Colvile, and

yet I shrank from troubling even your more indirect Letter to Mrs.
Strachey, 19th
sympathetic sorrow with a letter. I am wondering Dec. 1880.
how far her health is in a state to endure this loss
—a loss which extends even to me, who only occasionally saw, but
was always cheered by, the expression of a wise and sweet nature,
which clearly shone in Sir James Colvile's manner and conversation.
One great comfort I believe she has—that of a sister's affection.

Here the letter is broken off. The pen which had delighted and
comforted so many minds and hearts here made its last mark.
The spring, which had broadened out into so wide a river of
speech, ceased to flow.
Little more remains to be told. On Monday the doctor treated
the case as one of laryngeal sore throat; and when Dr. Andrew
Clark came for consultation on Wednesday evening the
pericardium was found to be seriously affected. While the
doctors were at her bedside she had just time to whisper to me,
"Tell them I have great pain in the left side," before she became
unconscious. Her long illness in the autumn had left her no
power to rally. She passed away, about ten o'clock at night, on
the 22d December, 1880.
She died, as she would herself have chosen to die, without
protracted pain, and with every faculty brightly vigorous.
Her body rests in Highgate Cemetery, in the grave next to Mr.
Lewes. In sleet and snow, on a bitter day—the 29th December
—very many whom she knew, very many whom she did not
know, pressed to her grave-side with tributes of tears and
flowers.
Her spirit joined that choir invisible "whose music is the
gladness of the world."
 INDEX.
"Abode of Snow," by Andrew Wilson, iii. 190.
A breezy common, iii. 108.
"Adam Bede," progress of, i. 338;
second volume finished in Dresden, ii. 42;
£800 offered for copyright for four years, 47;
its history, 48-52;
author's love of, 51;
subscription to, 59;
cheap edition suggested by working man, 66;
sale increasing, 67, 68;
quoted in House of Commons, 69;
French translation proposed, 73;
additional £400 from publishers, 80;
fourth edition (5000) sold in a fortnight, 88;
sixth edition, 96;
seventh edition (2000), 101;
Blackwoods propose to pay £800 above agreed price, 101;
16,000 copies sold in one year, 105;
copyright conceded, 111;
third volume written in six weeks, 113.
"Adam Bede, Junior," a sequel, advertised, ii. 104.
"Address to the Working Men," by Felix Holt, iii. 18.
Adler, Dr. Hermann, appreciation of Jewish character in
"Deronda," iii. 207;
lecture on "Deronda" by, 215.
Æsthetic teaching the highest of all teaching, ii. 318.
Æsthetic, the, not a doctrinal teacher, iii. 237.
Afghanistan, effect of the sad news from, iii. 278.
"Agatha" sold to Fields & Osgood for Atlantic Monthly, iii. 63.
Aix to Vevey, journey to, iii. 205.
Allbut, Dr. Clifford, Leeds, iii. 41, 42.
Allingham, William, letter to, on Midland dialect, iii. 218;
on his poems, 226.
Altruism, the need of, iii. 178, 179.
Amalfi, grand drive, ii. 153.
America, interest in, i. 219;
the war in, anxiety regarding, ii. 242;
delight in descriptions of, iii. 115;
invited to visit, 118.
Amsterdam, Jewish synagogues in, ii. 317.
"An Inquiry concerning the Origin of Christianity," by Charles
Hennell, influence of, on George Eliot, i. 68;
read again with admiration, 119.
Anders, Mr., apologizes for the Liggins business, ii. 78.
Antwerp, pictures at, i. 239, 240.
Apennines, across the, ii. 168.
Application, persistence in, iii. 304.
Appreciation of Dickens's letter, ii. 6.
Ardennes, journey to the, iii. 176.
"Aristotle," by G. H. Lewes, ii. 271.
"Armgart," a dramatic poem, iii. 85.
Art, the function of, iii. 144;
purpose in, 144.
Articles written by Mr. Lewes, iii. 260, 261;
by military men, 265.
Ashantee War, the, iii. 157.
Asher's cheap editions of "George Eliot," iii. 124.
Atkinson, Mr., i. 193.
Australia, proposed visit to, i. 221.
Authors and booksellers, meeting of, i. 201.
Authorship acknowledged to the Brays and Miss Hennell, ii. 83.
Autobiography, repugnance to, iii. 221.
Autumn, love for, i. 67; ii. 263, 264.
"A Word for the Germans," ii. 288.
Aytoun, Professor, admiration of "Gilfil's Love-Story," i. 326;
on "Adam Bede," ii. 81.
Bâle, a morning in, ii. 87.
Ballot, dislike of the, iii. 49;
the first experiment of the, 161.
Balzac, a saying of, iii, 41.
Bancroft, American Minister, Berlin, on "Middlemarch," iii. 157.
Bank of England visited, iii. 176.
"Beata," by T. A. Trollope, ii. 239.
Bedworth, country about, i. 5-7.
Beesley, Professor Edmund Spencer, iii. 64.
Bellagio and the Splügen Pass, ii. 181.
Benisch, Dr., editor of Jewish Chronicle, iii. 216.
Berlin, popularity of "Middlemarch" in, iii. 157.
Berlin, visit to the Charité, iii. 77;
society and music at, 77;
increase in luxury in, 78.
Berlin recollections: meets Varnhagen, i. 251, 252;
impressions of the city, 251;
new acquaintances, 253;
portrait of Kleist, 253;
Fräulein Solmar's salon, 253;
General Pfuhl, 254;
Baron Sternberg, 254;
"Lisez les Chroniques," 254;
Professor Gruppe, 255, 263;
Waagen on Goethe, 256;
Edward Magnus, 257;
celebrities, 258;
Professor Stahr, 258, 263;
Schiller's portrait, 258;
Rauch the sculptor, 258;
his atelier, 259, 260;
Dessoir the actor, 260;
"Nathan der Weise," 261;
Johanna Wagner, 261;
Gluck's "Orpheus," 261;
Roger and Arabella Goddard, 264;
 Vivier anecdotes, 264, 265;
works of art, 265;
evenings in, 266;
table d'hôte, reading between the courses, 266;
work at and books read, 268;
translating Spinoza's "Ethics," 268;
remarks on books read, 270;
return to England, 271.
Bethnal Green, pictures at, iii. 128.
Biarritz, its natural beauties, iii. 2;
the Chambre de l'Amour, 2;
journey to Barcelona from, 4.
Bible and the Liturgy of the English Church, ii. 226.
Bible reading, iii. 302.
Bickley, country-house at, iii. 152.
Birthday greetings, iii. 47.
Bishop Steignton, visit to, i. 185.
Blackie, Professor, Edinburgh, letter of sympathy from, ii. 111,
113.
Blackwood's Magazine on "Adam Bede," ii. 70.
Blackwood, John, his favorable opinion of "Amos Barton," i. 302;
accepts it for "Maga," 304;
receives kind letter from author, 307;
cautions regarding "huddling up stories," 319;
not enthusiastic about "Janet's Repentance," 326;
calls on Lewes, and George Eliot reveals herself, ii. 10;
letter from George Eliot on artistic combination, 31;
offers £800 for copyright of "Adam Bede" for four years,
47;
letter to, regarding Liggins, 73;
his liberal treatment of George Eliot, 102;
proposals for "Mill on the Floss," 110;
concedes copyright of "Adam Bede," 111;
suggests title of "Mill on the Floss," 112;
letter from author on finishing "Mill on the Floss," 114;
letter to, from George Eliot at Berne, 182, 183;
 do. from Florence, 218;
offers £5000 for "Felix Holt," 308;
letters to, about "Spanish Gypsy," iii. 16, 26;
about Scott Commemoration, 97;
"Middlemarch," 103;
his favorable impressions of "Middlemarch," 106;
letter to, from Homburg, 123;
New Year's greetings from George Eliot, 138;
letter on "Middlemarch," 153;
on another book simmering in her head, 157;
on corrected edition of "Spanish Gypsy," 161, 162;
letter to, with volume of poems, 164;
on printing of "Deronda," 190, 191, 197;
on re-reading "Romola," 217, 218;
offers for second ten-years' copyright, 230;
letter to, declining invitation to Strathtyrum, 237;
on her continued ill-health, 244;
his death, 276.
Blackwood, Major, his opinion of "Amos Barton," i. 306;
hopeful about the "Scenes," 342;
calls on Lewes, and suspects identity of George Eliot, 342;
letter regarding the Liggins affair, ii. 81;
letter from author on "Mill on the Floss," 167.
Blackwood, William, his favorable news of "Clerical Life," ii. 116;
letter to, on Mr. Lewes's illness, iii. 239;
on "Theophrastus Such," 254, 263, 271.
Blanc, Louis, anecdote of, i. 195.
Bodichon, Madame, discovers author of "Adam Bede," ii. 77;
letters to: on artistic combinations, 93;
on Mrs. Gaskell's letter, 107;
the rewards of the artist, 107;
on settling in London, 198;
on religious forms and ceremonies, 205;
on the necessity of sympathy, 268;
on her Spanish tour, iii. 4;
on cheerfulness, 172;
 on "Deronda," 198;
on woman's work, 208;
on her illness, 225;
on improvement in health, 252;
letter regarding "Lewes Studentship," 267;
letter announcing her marriage, 283;
on sympathy with marriage, 289.
Bohn, Madame, visit from, ii. 293.
Bologna, its pictures and churches, ii. 169;
the leaning towers, 170.
Bonham-Carter, Miss, letter to, from Madame Bodichon, iii. 264.
Bonheur, Rosa, her pictures, i. 333.
Books belong to successive mental phases, ii. 211.
Books read at Malvern, 1861, ii. 228-230, 234-236.
Books read, with remarks on, i. 268-271, 322, 341, 344; ii. 58,
299; iii. 25, 41, 68, 71, 72.
Booksellers and authors, meeting of, i. 201.
Bookstalls, literary taste at, iii. 51.
Brabant, Miss, i. 85.
Bracebridge, Mr., and Liggins, ii. 99.
Bray, Charles, his work, "The Philosophy of Necessity," i. 67;
influence of his opinions, 68;
words of affection in time of depression, 135;
letter to, on rumors of authorship, ii. 13.
Bray, Mrs., letters to: on favorite books, i. 86;
reading and music, 87;
poetry of Christianity, 93;
chameleon-like nature, 158;
orthodox friends, 162;
anxiety for letters, 164;
need of encouragement, 165;
life in Geneva, 169, 170;
Christmas wishes, 174;
severe winter, 175;
yearning for friends at home, 175;
a singular advertisement, 195;
 Westminster reviewers, 199;
love for music, 202;
feels well and "plucky," 207;
in Edinburgh again, 211;
pleasant travelling, 213;
a Saturday's work, 214;
work in the Strand, 215;
domestic grievances, 229;
view of union with Mr. Lewes, 235;
on careless cooking, 316;
on the charms of Richmond Park, 326;
unbelief in others' love, 337;
authorship acknowledged to, ii. 83;
recollections of journey of 1849, 191;
asking for music, 241;
on her "Physiology for Schools," 267;
on writing poetry instead of novels, iii. 31;
on happiness in recovery, 313.
Bremer, Frederica, i. 188, 190.
Brewing interest in Parliament, the, iii. 188, 189.
Brewster, Sir David, i. 190.
Bridges, Dr., Leeds, iii. 42.
Bright on Ireland, iii. 56.
Brittany, trip to, ii. 296.
Broadstairs, delight with, i. 205.
Brodie, Sir Benjamin, iii. 80.
Brontë, Charlotte, life of, i. 317.
Brooks, Shirley, delighted with "Adam Bede," ii. 70.
"Brother Jacob" written, ii. 199.
"Brother and Sister," sonnets, iii. 70.
Brougham, Lord, a delicious non sequitur, i. 214.
Brown, Dr. John, sends "Rab and his Friends" to author of
"Adam Bede," ii. 60;
kindly letter in reply, 60.
Brown, J. C., "Ethics of George Eliot's Works," iii. 266.
Browne, Dr., chemist, Edinburgh, i. 195.
Browning, first visit from, ii. 249;
"Elisha," iii. 56.
Browning, Mrs., her "Casa Guidi Windows", ii. 243.
Buchanan, Robert, his "David Grey," ii. 273.
Buckle, personal dislike to, ii. 47.
Buckle's "History of Civilization," i. 341, 345.
Buckle's ideal not George Eliot's, ii. 220.
Bulstrode, new view of, iii. 133.
Bunyan, reading again with pleasure, ii. 105.
Burne-Jones, Edward, letter to, on the function of art, iii. 144.
Burne-Jones, Mrs., iii. 29;
letter to, on the serious view of life, 172;
on her illness, 185;
on Christmas plans, 232;
on her sense of depression, 239.
Burton, Mr., wishes to take portrait, ii. 273;
his picture of a knight in armor, 277.
Burton, Sir Frederick, Director of the National Gallery, ii. 240.
Byron, a vulgar-minded genius, iii. 72.

Call, Mr., author of "Reverberations and other Poems," i. 335.

Calvinism, a libel on, iii. 88.
Camaldoli, expedition to, ii. 221.
Cambridge, a visit to, iii. 147;
a group of "Trinity" men, 147.
Cambridgeshire, visit to, iii. 299.
Caricature, a bastard kind of satire, iii. 228.
Caritas, the highest love, ii. 252.
Carlyle, Mrs., pleasant letter from, ii. 7;
her conception of George Eliot, 8.
Carlyle, on the Glasgow artisan, i. 55;
eulogium on Emerson, 140;
"Life of Sterling," 189;
anecdotes of, 190, 257;
his denunciation of the opera, 192;
letter to George Eliot on "Frederic," 343;
 G. A. anxious he should read her novels, ii. 63.
"Carlyle's Memoirs," ii. 208.
Catholicity of judgment, iii. 307.
Cavour, Count, ii. 122, 143.
Cerebellum, function of the, i. 210.
Chapman, Mrs., on Harriet Martineau, iii. 220.
Charade party, failure of, ii. 287.
Charity of the Apostle Paul, the, ii. 251.
Chart of Ecclesiastical History, i. 45.
Cheap books, opinion of, iii. 154.
Cheap edition of "Adam Bede" suggested by working man, ii.
66.
Cheap editions of novels, arrangements for, iii. 10.
Cheap music in England, ii. 81.
Cheerful, now uniformly, iii. 172.
Chiem See, journey by, ii. 34.
Childhood's real feelings, i. 91.
Child's idea of God, a, i. 153, 154.
Chills, spiritual and physical, iii. 120.
Chioggia, journey to, ii. 177.
"Christianity and Infidelity," Baillie Prize Essay, i. 311.
Chronological order in writing, ii. 211.
Church-going resumed, i. 82.
Clark, Sir James, pleasant evening with, i. 222;
meeting with, 226, 230.
Clark, W. G., late public orator at Cambridge, ii. 240;
visit to, at Cambridge, iii. 24;
resigns his oratorship, 74.
"Clerical Tutor," discouraged to proceed with, i. 336.
Club criticism of "Amos Barton," i. 308.
Coaching days, i. 7.
Cobbe, Miss, her introduction to Theodore Parker, ii. 253.
Cobden, disappointed with, i. 196.
Cologne, journey to, i. 267.
Colossians, Epistle to the, i. 51.
Combe, George, friendship with, i. 186;
 on the Westminster, 204;
visit to, in Edinburgh, 211.
Comprehensive Church, one, iii. 175.
Comte and his critics, ii. 224;
admiration of, 224;
delight in his "Politique," iii. 2.
Comte's "Discours Préliminaire," ii. 264.
Comte's works, reading, iii. 302.
Conceptions of new work, iii. 233.
Confidence, desire for, i. 128.
Conformity, letter to J. W. Cross on, iii. 155.
Congreve, Mrs., letters to, ii. 82, 84, 141;
visits George Eliot in London, 232;
letter to, on Thornton Lewes's illness, iii. 63;
leaves for India, 132;
returns to Europe, 145;
letter to, after marriage with Mr. Cross, 292;
invited to Cheyne Walk, 314.
Congreve, Richard, ii. 62, 67, 73;
friendship of Mr. and Mrs., 76, 80;
Christmas Day with, 110;
his lectures on Positivism, iii. 12;
his article Huxley on Comte, 58.
Conolly, Dr., i. 233.
Conscience in work, iii. 27.
Conservative reaction, on the, iii. 143.
Contemporary fiction, iii. 183.
Continent, start for, visiting Fontainebleau, Plombières, iii. 149;
three months' trip to the, 205.
Continental tour, six weeks' journey to Baden, etc., iii. 37;
St. Märgen, 37;
peasant proprietors in the Black Forest, 38.
Continental trip with the Brays, i. 150.
Coquelin's acting, iii. 263.
Correggio's Madonnas, ii. 43.
Correspondence, views on, i. 134.
Country, delight in the, iii. 154.
Country districts, remoteness of, i. 5.
Country-house, visions of a, ii. 61.
Country life, monotony of, i. 25;
enjoyment of, ii. 275.
Country quiet, the benefits of, iii. 110.
Critical attitude, the, iii. 79.
Criticism, sensibility to, ii. 63.
Critics, indifference to opinions of, iii. 224.
Cross, J. W., first meeting at Rome with George Eliot, iii. 59;
meet again at Weybridge, 71;
letter to, on buying a house, 131;
on conformity, 155;
on depression, 187;
on effect of her writing, 204;
on Tennyson, 229;
letters to, after Lewes's death, 250-252;
his engagement, 279;
his marriage, 282;
illness in Venice, 294.
Cross, Miss Eleanor, letter to, iii. 276;
on her engagement to Mr. Cross, 279;
on her marriage tour, 283.
Cross, Miss Elizabeth D., "An Old Story and other Poems," iii. 15.
Cross, Miss Florence, letter to from Milan on the enjoyment of
travel, iii. 286.
Cross, Miss Mary, her "Marie of Villefranche," iii. 100;
letter to, on gift of a vase, 166.
Cross, Mrs., letters to, accepting invitation to Six-Mile Bottom, iii.
121;
letter to, from Homburg, 122;
on return home, 125;
on journey abroad, and country-house at Bickley, 152;
on the pleasures of the country, 154;
on Christmas invitation, 158;
on silence of the country, 167.
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