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When the clock struck, Andrey Yefimitch would sink back into his chair and close his eyes to think a little. And under the influence of the fine ideas of which he had been reading he would, unawares, recall his past and his present. The past was hateful — better not to think of it. And it was the same in the present as in the past. He knew that at the very time when his thoughts were floating together with the cooling earth round the sun, in the main building beside his abode people were suffering in sickness and physical impurity: someone perhaps could not sleep and was making war upon the insects, someone was being infected by erysipelas, or moaning over too tight a bandage; perhaps the patients were playing cards with the nurses and drinking vodka. According to the yearly return, twelve thousand people had been deceived; the whole hospital rested as it had done twenty years ago on thieving, filth, scandals, gossip, on gross quackery, and, as before, it was an immoral institution extremely injurious to the health of the inhabitants. He knew that Nikita knocked the patients about behind the barred windows of Ward No. 6, and that Moiseika went about the town every day begging alms.

On the other hand, he knew very well that a magical change had taken place in medicine during the last twenty-five years. When he was studying at the university he had fancied that medicine would soon be overtaken by the fate of alchemy and metaphysics; but now when he was reading at night the science of medicine touched him and excited his wonder, and even enthusiasm. What unexpected brilliance, what a revolution! Thanks to the antiseptic system operations were performed such as the great Pirogov had considered impossible even in spe. Ordinary Zemstvo doctors were venturing to perform the resection of the kneecap; of abdominal operations only one per cent. was fatal; while stone was considered such a trifle that they did not even write about it. A radical cure for syphilis had been discovered. And the theory of heredity, hypnotism, the discoveries of Pasteur and of Koch , hygiene based on statistics, and the work of Zemstvo doctors!

Psychiatry with its modern classification of mental diseases, methods of diagnosis, and treatment, was a perfect Elborus in comparison with what had been in the past. They no longer poured cold water on the heads of lunatics nor put strait-waistcoats upon them; they treated them with humanity, and even, so it was stated in the papers, got up balls and entertainments for them. Andrey Yefimitch knew that with modern tastes and views such an abomination as Ward No. 6 was possible only a hundred and fifty miles from a railway in a little town where the mayor and all the town council were half-illiterate tradesmen who looked upon the doctor as an oracle who must be believed without any criticism even if he had poured molten lead into their mouths; in any other place the public and the newspapers would long ago have torn this little Bastille to pieces.

“But, after all, what of it?” Andrey Yefimitch would ask himself, opening his eyes.”There is the antiseptic system, there is Koch, there is Pasteur, but the essential reality is not altered a bit; ill-health and mortality are still the same. They get up balls and entertainments for the mad, but still they don’t let them go free; so it’s all nonsense and vanity, and there is no difference in reality between the best Vienna clinic and my hospital.” But depression and a feeling akin to envy prevented him from feeling indifferent; it must have been owing to exhaustion. His heavy head sank on to the book, he put his hands under his face to make it softer, and thought: “I serve in a pernicious institution and receive a salary from people whom I am deceiving. I am not honest, but then, I of myself am nothing, I am only part of an inevitable social evil: all local officials are pernicious and receive their salary for doing nothing…. And so for my dishonesty it is not I who am to blame, but the times…. If I had been born two hundred years later I should have been different…”