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 Yefimitch
knew that such surroundings were torture to feverish, consumptive, and
impressionable patients; but what could be done? In the consulting-room
he was met by his assistant, Sergey Sergeyitch--a fat little man with a
plump, well-washed shaven face, with soft, smooth manners, wearing a new
loosely cut suit, and looking more like a senator than a medical
assistant. He had an immense practice in the town, wore a white tie, and
considered himself more proficient than the doctor, who had no practice.
In the corner of the consulting-room there stood a large ikon in a
shrine with a heavy lamp in front of it, and near it a candle-stand with
a white cover on it. On the walls hung portraits of bishops, a view of
the Svyatogorsky Monastery, and wreaths of dried cornflowers. Sergey
Sergeyitch was religious, and liked solemnity and decorum. The ikon had
been put up at his expense; at his instructions some one of the patients
read the hymns of praise in the consulting-room on Sundays, and after
the reading Sergey Sergeyitch himself went through the wards with a
censer and burned incense.
There were a great many patients, but the time was short, and so the
work was confined to the asking of a few brief questions and the
administration of some drugs, such as castor-oil or volatile ointment.
Andrey Yefimitch would sit with his cheek resting in his hand, lost in
thought and asking questions mechanically. Sergey Sergeyitch sat down
too, rubbing his hands, and from time to time putting in his word.
"We suffer pain and poverty," he would say, "because we do not pray to
the merciful God as we should. Yes!"
Andrey Yefimitch never performed any operation when he was seeing
patients; he had long ago given up doing so, and the sight of blood
upset him. When he had to open a child's mouth in order to look at its
throat, and the child cried and tried to defend itself with its little
hands, the noise in his ears made his head go round and brought tears to
his eyes. He would make haste to prescribe a drug, and motion to the
woman to take the child away.
He was soon wearied by the timidity of the patients and their
incoherence, by the proximity of the pious Sergey Sergeyitch, by the
portraits on the walls, and by his own questions which he had asked over
and over again for twenty years. And he would go away after seeing five
or six patients. The rest would be seen by his assistant in his absence.
With the agreeable thought that, thank God, he had no private practice
now, and that no one would interrupt him, Andrey Yefimitch sat down to
the table immediately on reaching home and took up a book. He read a
great deal and always with enjoyment. Half his salary went on buying
books, and of the six rooms that made up his abode three were heaped up
with books and old magazines. He liked best of all works on history and
philosophy; the only medical publication to which he subscribed was The
Doctor, of which he always read the last pages first. He would always go
on reading for several hours without a break and without being weary. He
did not read as rapidly and impulsively as Ivan Dmitritch had done in
the past, but slowly and with concentration, often pausing over a
passage which he liked or did not find intelligible. Near the books
there always stood a decanter of vodka, and a salted cucumber or a
pickled apple lay beside it, not on a plate, but on the baize table-
cloth. Every half-hour he would pour himself out a glass of vodka and
drink it without taking his eyes off the book. Then without looking at
it he would feel for the cucumber and bite off a bit.
At three o'clock he would go cautiously to the kitchen door; cough, and
say, "Daryushka, what about dinner? . ."
After his dinner--a rather poor and untidily served one--Andrey Yefimitch
would walk up and down his rooms with his arms folded, thinking. The
clock would strike four, then five, and still he would be walking up and
down thinking. Occasionally the kitchen door would creak, and the red
and sleepy face of Daryushka would appear.
"Andrey Yefimitch, isn't it time for you to have your beer?" she would
ask anxiously.
"No, it's not time yet . . ." he would answer. "I'll wait a little . . .
. I'll wait a little. . ."
Towards the evening the postmaster, Mihail Averyanitch, the only man in
town whose society did not bore Andrey Yefimitch, would come in. Mihail
Averyanitch had once been a very rich landowner, and had served in the
calvary, but had come to ruin, and was forced by poverty to take a job
in the post office late in life. He had a hale and hearty appearance,
luxuriant grey whiskers, the manners of a well-bred man, and a loud,
pleasant voice. He was good-natured and emotional, but hot-tempered.
When anyone in the post office made a protest, expressed disagreement,
or even began to argue, Mihail Averyanitch would turn crimson, shake all
over, and shout in a voice of thunder, "Hold your tongue!" so that the
post office had long enjoyed the reputation of an institution which it
was terrible to visit. Mihail Averyanitch liked and respected Andrey
Yefimitch for his culture and the loftiness of his soul; he treated the
other inhabitants of the town superciliously, as though they were his
subordinates.
"Here I am," he would say, going in to Andrey Yefimitch. "Good evening,
my dear fellow! I'll be bound, you are getting sick of me, aren't you?"
"On the contrary, I am delighted," said the doctor. "I am always glad to
see you."
The friends would sit on the sofa in the study and for some time would
smoke in silence.
"Daryushka, what about the beer?" Andrey Yefimitch would say.
They would drink their first bottle still in silence, the doctor
brooding and Mihail Averyanitch with a gay and animated face, like a man
who has something very interesting to tell. The doctor was always the
one to begin the conversation.
"What a pity," he would say quietly and slowly, not looking his friend
in the face (he never looked anyone in the face)--"what a great pity it
is that there are no people in our town who are capable of carrying on
intelligent and interesting conversation, or care to do so. It is an
immense privation for us. Even the educated class do not rise above
vulgarity; the level of their development, I assure you, is not a bit
higher than that of the lower orders."
"Perfectly true. I agree."
"You know, of course," the doctor went on quietly and deliberately,
"that everything in this world is insignificant and uninteresting except
the higher spiritual manifestations of the human mind. Intellect draws a
sharp line between the animals and man, suggests the divinity of the
latter, and to some extent even takes the place of the immortality which
does not exist. Consequently the intellect is the only possible source
of enjoyment. We see and hear of no trace of intellect about us, so we
are deprived of enjoyment. We have books, it is true, but that is not at
all the same as living talk and converse. If you will allow me to make a
not quite apt comparison: books are the printed score, while talk is the
singing."
"Perfectly true."
A silence would follow. Daryushka would come out of the kitchen and with
an expression of blank dejection would stand in the doorway to listen,
with her face propped on her fist.
"Eh!" Mihail Averyanitch would sigh. "To expect intelligence of this
generation!"
And he would describe how wholesome, entertaining, and interesting life
had been in the past. How intelligent the educated class in Russia used
to be, and what lofty ideas it had of honour and friendship; how they
used to lend money without an IOU, and it was thought a disgrace not to
give a helping hand to a comrade in need; and what campaigns, what
adventures, what skirmishes, what comrades, what women! And the
Caucasus, what a marvellous country! The wife of a battalion commander,
a queer woman, used to put on an officer's uniform and drive off into
the mountains in the evening, alone, without a guide. It was said that
she had a love affair with some princeling in the native village.
"Queen of Heaven, Holy Mother..." Daryushka would sigh.
"And how we drank! And how we ate! And what desperate liberals we were!"
Andrey Yefimitch would listen without hearing; he was musing as he
sipped his beer.
"I often dream of intellectual people and conversation with them," he
said suddenly, interrupting Mihail Averyanitch. "My father gave me an
excellent education, but under the influence of the ideas of the sixties
made me become a doctor. I believe if I had not obeyed him then, by now
I should have been in the very centre of the intellectual movement. Most
likely I should have become a member of some university. Of course,
intellect, too, is transient and not eternal, but you know why I cherish
a partiality for it. Life is a vexatious trap; when a thinking man
reaches maturity and attains to full consciousness he cannot help
feeling that he is in a trap from which there is no escape. Indeed, he
is summoned without his choice by fortuitous circumstances from non-
existence into life . . . what for? He tries to find out the meaning and
object of his existence; he is told nothing, or he is told absurdities;
he knocks and it is not opened to him; death comes to him--also without
his choice. And so, just as in prison men held together by common
misfortune feel more at ease when they are together, so one does not
notice the trap in life when people with a bent for analysis and
generalization meet together and pass their time in the interchange of
proud and free ideas. In that sense the intellect is the source of an
enjoyment nothing can replace."
"Perfectly true."
Not looking his friend in the face, Andrey Yefimitch would go on,
quietly and with pauses, talking about intellectual people and
conversation with them, and Mihail Averyanitch would listen attentively
and agree: "Perfectly true."
"And you do not believe in the immortality of the soul?" he would ask
suddenly.
"No, honoured Mihail Averyanitch; I do not believe it, and have no
grounds for believing it."
"I must own I doubt it too. And yet I have a feeling as though I should
never die. Oh, I think to myself: 'Old fogey, it is time you were dead!'
But there is a little voice in my soul says: 'Don't believe it; you
won't die.'"
Soon after nine o'clock Mihail Averyanitch would go away. As he put on
his fur coat in the entry he would say with a sigh:
"What a wilderness fate has carried us to, though, really! What's most
vexatious of all is to have to die here. Ech! . ." VII
After seeing his friend out Andrey Yefimitch would sit down at the table
and begin reading again. The stillness of the evening, and afterwards of
the night, was not broken by a single sound, and it seemed as though
time were standing still and brooding with the doctor over the book, and
as though there were nothing in existence but the books and the lamp
with the green shade. The doctor's coarse peasant-like face was
gradually lighted up by a smile of delight and enthusiasm over the
progress of the human intellect. Oh, why is not man immortal? he
thought. What is the good of the brain centres and convolutions, what is
the good of sight, speech, self-consciousness, genius, if it is all
destined to depart into the soil, and in the end to grow cold together
with the earth's crust, and then for millions of years to fly with the
earth round the sun with no meaning and no object? To do that there was
no need at all to draw man with his lofty, almost godlike intellect out
of non-existence, and then, as though in mockery, to turn him into clay.
The transmutation of substances! But what cowardice to comfort oneself
with that cheap substitute for immortality! The unconscious processes
that take place in nature are lower even than the stupidity of man,
since in stupidity there is, anyway, consciousness and will, while in
those processes there is absolutely nothing. Only the coward who has
more fear of death than dignity can comfort himself with the fact that
his body will in time live again in the grass, in the stones, in the
toad. To find one's immortality in the transmutation of substances is as
strange as to prophesy a brilliant future for the case after a precious
violin has been broken and become useless.
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. . ."
When it struck three he would put out his lamp and go into his bedroom;
he was not sleepy. VIII
Two years before, the Zemstvo in a liberal mood had decided to allow
three hundred roubles a year to pay for additional medical service in
the town till the Zemstvo hospital should be opened, and the district
doctor, Yevgeny Fyodoritch Hobotov, was invited to the town to assist
Andrey Yefimitch. He was a very young man--not yet thirty--tall and dark,
with broad cheek-bones and little eyes; his forefathers had probably
come from one of the many alien races of Russia. He arrived in the town
without a farthing, with a small portmanteau, and a plain young woman
whom he called his cook. This woman had a baby at the breast. Yevgeny
Fyodoritch used to go about in a cap with a peak, and in high boots, and
in the winter wore a sheepskin. He made great friends with Sergey
Sergeyitch, the medical assistant, and with the treasurer, but held
aloof from the other officials, and for some reason called them
aristocrats. He had only one book in his lodgings, "The Latest
Prescriptions of the Vienna Clinic for 1881." When he went to a patient
he always took this book with him. He played billiards in the evening at
the club: he did not like cards. He was very fond of using in
conversation such expressions as "endless bobbery," "canting soft soap,"
"shut up with your finicking. . ."
He visited the hospital twice a week, made the round of the wards, and
saw out-patients. The complete absence of antiseptic treatment and the
cupping roused his indignation, but he did not introduce any new system,
being afraid of offending Andrey Yefimitch. He regarded his colleague as
a sly old rascal, suspected him of being a man of large means, and
secretly envied him. He would have been very glad to have his post. IX
On a spring evening towards the end of March, when there was no snow
left on the ground and the starlings were singing in the hospital
garden, the doctor went out to see his friend the postmaster as far as
the gate. At that very moment the Jew Moiseika, returning with his
booty, came into the yard. He had no cap on, and his bare feet were
thrust into goloshes; in his hand he had a little bag of coppers.
"Give me a kopeck!" he said to the doctor, smiling, and shivering with
cold. Andrey Yefimitch, who could never refuse anyone anything, gave him
a ten-kopeck piece.
"How bad that is!" he thought, looking at the Jew's bare feet with their
thin red ankles. "Why, it's wet."
And stirred by a feeling akin both to pity and disgust, he went into the
lodge behind the Jew, looking now at his bald head, now at his ankles.
As the doctor went in, Nikita jumped up from his heap of litter and
stood at attention.
"Good-day, Nikita," Andrey Yefimitch said mildly. "That Jew should be
provided with boots or something, he will catch cold."
"Certainly, your honour. I'll inform the superintendent."
"Please do; ask him in my name. Tell him that I asked."
The door into the ward was open. Ivan Dmitritch, lying propped on his
elbow on the bed, listened in alarm to the unfamiliar voice, and
suddenly recognized the doctor. He trembled all over with anger, jumped
up, and with a red and wrathful face, with his eyes starting out of his
head, ran out into the middle of the road.
"The doctor has come!" he shouted, and broke into a laugh. "At last!
Gentlemen, I congratulate you. The doctor is honouring us with a visit!
Cursed reptile!" he shrieked, and stamped in a frenzy such as had never
been seen in the ward before. "Kill the reptile! No, killing's too good.
Drown him in the midden-pit!"
Andrey Yefimitch, hearing this, looked into the ward from the entry and
asked gently: "What for?"
"What for?" shouted Ivan Dmitritch, going up to him with a menacing air
and convulsively wrapping himself in his dressing-gown. "What for?
Thief!" he said with a look of repulsion, moving his lips as though he
would spit at him. "Quack! hangman!"
"Calm yourself," said Andrey Yefimitch, smiling guiltily. "I assure you
I have never stolen anything; and as to the rest, most likely you
greatly exaggerate. I see you are angry with me. Calm yourself, I beg,
if you can, and tell me coolly what are you angry for?"
"What are you keeping me here for?"
"Because you are ill."
"Yes, I am ill. But you know dozens, hundreds of madmen are walking
about in freedom because your ignorance is incapable of distinguishing
them from the sane. Why am I and these poor wretches to be shut up here
like scapegoats for all the rest? You, your assistant, the
superintendent, and all your hospital rabble, are immeasurably inferior
to every one of us morally; why then are we shut up and you not? Where's
the logic of it?"
"Morality and logic don't come in, it all depends on chance. If anyone
is shut up he has to stay, and if anyone is not shut up he can walk
about, that's all. There is neither morality nor logic in my being a
doctor and your being a mental patient, there is nothing but idle
chance."
"That twaddle I don't understand. . ." Ivan Dmitritch brought out in a
hollow voice, and he sat down on his bed.
Moiseika, whom Nikita did not venture to search in the presence of the
doctor, laid out on his bed pieces of bread, bits of paper, and little
bones, and, still shivering with cold, began rapidly in a singsong voice
saying something in Yiddish. He most likely imagined that he had opened
a shop.
"Let me out," said Ivan Dmitritch, and his voice quivered.
"I cannot."
"But why, why?"
"Because it is not in my power. Think, what use will it be to you if I
do let you out? Go. The townspeople or the police will detain you or
bring you back."
"Yes, yes, that's true," said Ivan Dmitritch, and he rubbed his
forehead. "It's awful! But what am I to do, what?"
Andrey Yefimitch liked Ivan Dmitritch's voice and his intelligent young
face with its grimaces. He longed to be kind to the young man and soothe
him; he sat down on the bed beside him, thought, and said:
"You ask me what to do. The very best thing in your position would be to
run away. But, unhappily, that is useless. You would be taken up. When
society protects itself from the criminal, mentally deranged, or
otherwise inconvenient people, it is invincible. There is only one thing
left for you: to resign yourself to the thought that your presence here
is inevitable."
"It is no use to anyone."
"So long as prisons and madhouses exist someone must be shut up in them.
If not you, I. If not I, some third person. Wait till in the distant
future prisons and madhouses no longer exist, and there will be neither
bars on the windows nor hospital gowns. Of course, that time will come
sooner or later."
Ivan Dmitritch smiled ironically.