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Up to this point, Casaubon has never displayed any fear of or even interest in his medical condition. But as the suspicion and jealousy of Ladislaw grows, he feels the need to know how much of life is left to him.
He sends for Lydgate. Casaubon is locked into his loneliness and frustration. Every gesture of Dorothea’s seems to him to reveal a critical and rebellious outlook. He dreads her pity.
He feels sure Ladislaw has come to Tipton to be near her. While he does not doubt her loyalty, he suspects every act of Ladislaw and think of how he can be defeated. He becomes secretive.
Hence, he arranges for Lydgate to meet him while out walking alone. He asks the doctor for a frank assessment and gets it. Lydgate reveals that he suffers from "fatty degeneration of the heart." While, with proper care, he could live a dozen years, it is also possible he may die suddenly. Casaubon inquires whether Dorothea knows about this. Dorothea says a she does.
Casaubon receives the news with his usual reserve. Feeling his need to be alone, Lydgate takes his leave. Dorothea has been waiting to go to her husband. Seeing Lydgate leave, she goes and puts her hand through his arm. Casaubon is unresponsive. When they enter the house, he retires to the library. Dorothea is bitterly hurt, then resentful. She refuses to have dinner, then struggles with her own hostile impulses till she achieves a sort of calm. Late at night, she waits till he emerges to go to bed. This time he is gentle and considerate when she approaches. Thus, they reconcile with each other.
Here, George Eliot compensates for her earlier neglect of Casaubon by entering into his deepest fears and insecurities. Initially, even the choice of the name "Casaubon" - that of a great renaissance scholar - was intended to be ironic. But here she confronts the personal tragedy of a human being. When the commonplace, "We must all die" transforms itself suddenly into the acute consciousness, "I must die - and soon," then death grapples us, and his fingers are cruel.
The author also delves into Casaubon’s own viewpoint regarding will Ladislaw, and his obsessive brooding over his now hated cousin. This prepares us for the idea that Casaubon intends to manipulate the future through the only instrument available - his property. Property, as in Featherstone’s case, is at the center of a complicated web of human relationships in the novel.
This chapter ends Book IV of the novel, which sees the engagement of Lydgate and Rosamond, the temporary separation of Fred and Mary, and the inevitable end of Dorothea’s marriage drawing closer.