Bulstrode plans to name Lydgate as superintendent of the new Fever Hospital. Farebrother warns Lydgate that he will incur professional jealousy among other Middlemarch medical men because he wants to reform their outdated treatments. The hospital lies within Mr. Farebrother's parish, but Bulstrode wishes to elect another clergyman because he doesn't like Farebrother's doctrine. He wishes to elect Mr. Tyke as chaplain for the hospital. Lydgate replies that he doesn't want to become involved in clerical disputes.

Lydgate is the orphan son of a military man, and he settled on the medical profession at a young age. His guardians paid for his education, but he is forced to earn his own living, and he doesn't plan to marry soon. He once fell in love with an actress who killed her husband on stage. She reported that it was an accident, and Lydgate helped clear her of charges. She later confessed that she meant to do it, and he resolved to avoid romantic entanglements for a long while. He wants to discover the tissue that is the most basic building block of life.

Bulstrode arrived in Middlemarch some twenty years ago, and no one knows his origins. He managed to marry Mr. Vincy's sister and ally himself with an important, respectable family. He has an intimate view into the private lives of Middlemarch citizens through their finances. He uses his money as a lever to spread his strict Protestant ethic and to scrutinize its effect on his fellow citizens. Power is his favorite game.

Mr. Vincy arrives, and Lydgate is rescued from the sticky situation. Fred has told his father about Featherstone's request. Bulstrode is reluctant to write the letter because he disapproves of Fred's extravagant habits. He believes that Vincy made a mistake in paying for Fred's expensive college education. Vincy criticizes Bulstrode for moralizing and hints that his sister, Mrs. Bulstrode, will disapprove of Bulstrode's refusal to help her brother's family. Bulstrode agrees to write the letter after a short consultation with his wife.

Fred delivers the letter, and Featherstone gives him one hundred pounds as a gift. Fred retreats to speak with Mary. He doesn't want to be a clergyman, and he has failed his examination at college. Fred demands that she promise to marry him, but she refuses. She suggests that he pass his exam as proof that he is not an idler, even though she thinks he would be an unfit clergyman. She refuses to encourage his marriage prospects. Fred returns home in low spirits and asks his mother to hold eighty pounds. He owes one hundred and sixty pounds for a gambling debt. His creditor holds a bill signed by Mary's father as security against the debt.

Lydgate attends dinner at the Vincy household, where the debate over Tyke rages on. Vincy states his preference for Farebrother on matters of doctrine. Lydgate states that he only wants to choose the best man for the job, rather than the person he likes most. The debate turns to reforms of the medical profession, and Lydgate finds himself in the minority when he supports them. He inadvertently insults the Middlemarch coroner. He converses with Rosamond and finds her very much to his liking.