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After looking over the hospital Andrey Yefimitch came to the conclusion that it was an immoral institution and extremely prejudicial to the health of the townspeople. In his opinion the most sensible thing that could be done was to let out the patients and close the hospital. But he reflected that his will alone was not enough to do this, and that it would be useless; if physical and moral impurity were driven out of one place, they would only move to another; one must wait for it to wither away of itself Besides, if people open a hospital and put up with having it, it must be because they need it; superstition and all the nastiness and abominations of daily life were necessary, since in process of time they worked out to something sensible, just as manure turns into black earth. There was nothing on earth so good that it had not something nasty about its first origin.

When Andrey Yefimitch undertook his duties he was apparently not greatly concerned about the irregularities at the hospital. He only asked the attendants and nurses not to sleep in the wards, and had two cupboards of instruments put up; the superintendent, the housekeeper, the medical assistant, and the erysipelas remained unchanged.

Andrey Yefimitch loved intelligence and honesty intensely, but he had no strength of will nor belief in his right to organize an intelligent and honest life about him. He was absolutely unable to give orders, to forbid things, and to insist. It seemed as though he had taken a vow never to raise his voice and never to make use of the imperative. It was difficult for him to say.”Fetch” or “Bring”; when he wanted his meals he would cough hesitatingly and say to the cook, “How about tea?…” or “How about dinner? …” To dismiss the superintendent or to tell him to leave off stealing, or to abolish the unnecessary parasitic post altogether, was absolutely beyond his powers. When Andrey Yefimitch was deceived or flattered, or accounts he knew to be cooked were brought him to sign, he would turn as red as a crab and feel guilty, but yet he would sign the accounts. When the patients complained to him of being hungry or of the roughness of the nurses, he would be confused and mutter guiltily: “Very well, very well, I will go into it later…. Most likely there is some misunderstanding…”

At first Andrey Yefimitch worked very zealously. He saw patients every day from morning till dinner-time, performed operations, and even attended confinements. The ladies said of him that he was attentive and clever at diagnosing diseases, especially those of women and children. But in process of time the work unmistakably wearied him by its monotony and obvious uselessness. To-day one sees thirty patients, and to-morrow they have increased to thirty-five, the next day forty, and so on from day to day, from year to year, while the mortality in the town did not decrease and the patients did not leave off coming. To be any real help to forty patients between morning and dinner was not physically possible, so it could but lead to deception. If twelve thousand patients were seen in a year it meant, if one looked at it simply, that twelve thousand men were deceived. To put those who were seriously ill into wards, and to treat them according to the principles of science, was impossible, too, because though there were principles there was no science; if he were to put aside philosophy and pedantically follow the rules as other doctors did, the things above all necessary were cleanliness and ventilation instead of dirt, wholesome nourishment instead of broth made of stinking, sour cabbage, and good assistants instead of thieves; and, indeed, why hinder people dying if death is the normal and legitimate end of everyone? What is gained if some shop-keeper or clerk lives an extra five or ten years? If the aim of medicine is by drugs to alleviate suffering, the question forces itself on one: why alleviate it? In the first place, they say that suffering leads man to perfection; and in the second, if mankind really learns to alleviate its sufferings with pills and drops, it will completely abandon religion and philosophy, in which it has hitherto found not merely protection from all sorts of trouble, but even happiness. Pushkin suffered terrible agonies before his death, poor Heine lay paralyzed for several years; why, then, should not some Andrey Yefimitch or Matryona Savishna be ill, since their lives had nothing of importance in them, and would have been entirely empty and like the life of an amoeba except for suffering?