December 24, 1890.

I believe in Koch and in spermine and praise God for it. All that—that is the kochines, spermines, and so on—seem to the public a kind of miracle that leaped forth from some brain, after the fashion of Pallas Athene; but people who have a closer acquaintance with the facts know that they are only the natural sequel of what has been done during the last twenty years. A great deal has been done, my dear fellow! Surgery alone has done so much that one is fairly dumbfoundered at it. To one who is studying medicine now, the time before twenty years ago seems simply pitiable. My dear friend, if I were offered the choice between the “ideals” of the renowned “sixties,” or the very poorest Zemstvo hospital of to-day, I should, without a moment’s hesitation, choose the second.

Will kochine cure syphilis? It’s possible. But as for cancer, you must allow me to have my doubts. Cancer is not a microbe; it’s a tissue, growing in the wrong place, and like a noxious weed smothering all the neighbouring tissues. If N.‘s uncle feels better, that is, because the microbes of erysipelas—that is, the elements that produce the disease of erysipelas—form a component part of kochine. It was observed long ago that with the development of erysipelas, the growth of malignant tumours is temporarily checked.

It’s a strange business—while I was travelling to Sahalin and back I felt perfectly well, but now, at home, the devil knows what is happening to me. My head is continually aching, I have a feeling of languor all over, I am quickly exhausted, apathetic, and worst of all, my heart is not beating regularly. My heart is continually stopping for a few seconds....