Bulstrode places Lydgate in charge of a new hospital which will be "special destination for fevers" (173) such as tuberculosis or typhoid fever. However, Lydgate is warned that his innovative ideas for medical reform will prompt "jealousy and dislike" (174) from the other Middlemarch doctors. The location of the hospital means that Lydgate, as the hospital's superintendent, will be allowed to nominate a new priest for the local parish. Bulstrode does not like the current priest, the "deeply painful" (176) Farebrother, so he asks Lydgate to elect a fellow Evangelical named Mr. Tyke as the hospital's chaplain. Lydgate is unwilling to enter into political battles.

Mr. Vincy interrupts the discussion to invite the departing Lydgate for dinner. Once Lydgate is gone, Vincy turns to Bulstrode to discuss the letter requested by Featherstone to clear Fred's name amid the "nonsense" (180) rumors. Bulstrode is reluctant. He accuses Mr. Vincy of vainly trying to force his son into the church. In response, Vincy calls Bulstrode a hypocrite, a man who claims to be a good Christian but who engages in shady business deals. They argue a short while and then Bulstrode agrees to "probably" (184) write to Featherstone, for the sake of his wife.