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?

Oppressed by such reflections, Andrey Yefimitch relaxed his efforts and gave up visiting the hospital every day.

VI

His life was passed like this.  As a rule he got up at eight o’clock in the morning, dressed, and drank his tea.  Then he sat down in his study to read, or went to the hospital.  At the hospital the out-patients were sitting in the dark, narrow little corridor waiting to be seen by the doctor.  The nurses and the attendants, tramping with their boots over the brick floors, ran by them; gaunt-looking patients in dressing-gowns passed; dead bodies and vessels full of filth were carried by; the children were crying, and there was a cold draught.  Andrey