Chapter 3 offers a sustained reading of the nature of auditory perception in George Eliot’s Middlemarchin order to demonstrate the significance of listening and attentiveness not only to the pathological sounds of the body but to those metaphoric heart beats and vibrations that signify psychological struggles within the novel as a whole. In Eliot’s realist project, I argue, both medical and imaginative explorations of the vibrations and pulses beyond the thresholds of usual human ‘stupidity’ and sensory perception are stimulants to the imagination, but they are not a cause for horror or dread like those gothic treatments of the stethoscope discussed in the previous chapter. Rather, they offer an opportunity for cultivating medical knowledge, sympathy, and humility. Here, attentive, stethoscopic listening ultimately provides a means of discrimination, of knowing and orienting oneself, and of relating to others in the modern world.