Ferdinand returns to France and opens a practice in La Garenne-Rancy after a precarious interval of odd jobs and years of medical study. The episode turns his hoped-for fresh start into an encounter with a poor suburb where professional credentials bring little security and medical care is constrained by uncertainty, gossip, and deprivation.

Return and Medical Training

For weeks and months, Ferdinand lingers around Place Clichy and the Batignolles, taking whatever work he can find. The routine offers no clean break from the past: he describes the days as a precarious thread waiting to be picked up, while work in the heat of the traffic recalls the strain of Ford’s factory. In his free time, usually alone, he thinks over books, newspapers, and what he has seen.

He resumes his studies while working for a living, then passes his examinations after five or six years of academic difficulty. The degree gives him formal standing, but his sardonic view of medical education remains: science is guarded behind institutional barriers, and the qualification seems more impressive on paper than generous in what it provides.

Opening a Practice in Rancy

Ferdinand establishes himself in the suburbs, in La Garenne-Rancy just beyond the Porte Brancion on the way out of Paris. He does not set out with grand professional ambitions. He wants room to breathe and enough income to eat somewhat better, so he puts his nameplate above the door and waits for patients.

The local residents do not immediately trust the sign. They ask the police station whether he is a real doctor and learn that he has filed his diploma. Word then spreads that a qualified physician has opened among the neighborhood’s other doctors. His concierge predicts that he will never make a living because there are already too many practitioners; the narrator concedes that she is right. His arrival therefore establishes a practice, but not an assured livelihood.

The Neighborhood and Its Conditions

Rancy is presented through the daily movement of workers and the built environment that confines them. Streetcars begin running at dawn along Boulevard Minotaure, carrying people toward work. The young workers appear cheerful, clinging to the running boards and laughing, but Ferdinand’s perspective is shaped by long familiarity with the neighborhood’s squalor and routine. Its houses feel like prisons: their interiors are neglected, their façades flat, and their absent landlords deal with tenants through agents.

The setting also recalls Detroit. Rancy’s smoky sky, industrial chimneys, and buildings sunk in black urban grime make the suburb seem less like a new beginning than another version of the industrial landscape Ferdinand has left behind. His medical practice is planted in a place where poverty is ordinary and the environment itself offers little relief.

Medical Work and Its Limits

The later cases that follow the opening of the practice show what this position entails. At the Gagat household, Ferdinand is called to a young woman who is losing a great deal of blood. Her mother is consumed by fear of neighborhood judgment, and the father waits uncertainly in the next room. Ferdinand cannot resolve the emergency in the circumstances he finds, while the family’s concern about appearances obstructs a clear response. The episode exposes the distance between possessing a medical qualification and being able to secure effective care.

Bébert’s illness makes that limitation more prolonged and painful. Ferdinand treats the child for a severe, baffling case of typhoid, trying baths, serum, a dry diet, and vaccines without success. He seeks further advice at the Joseph Bioduret Institute, driven partly by the wish to know that he has tried everything possible. There he consults Serge Parapine, a former medical-school instructor who is willing to help but has accumulated so much contradictory knowledge that he cannot offer a definite view of treatment. Ferdinand’s professional responsibility persists even when the available expertise cannot give him certainty.

Bébert dies despite Ferdinand’s efforts, and the neighborhood’s judgment compounds the failure: gossip about an earlier case circulates, while other doctors are reluctant to take on the child once they know the illness. Ferdinand is retained because Bébert has already fallen to his care. The episode thus links his modest suburban opening to an enduring ethical burden: he must answer for outcomes he cannot control, even as poverty, suspicion, and the limits of medical knowledge narrow his choices.

Significance

The return and opening of the practice mark Ferdinand’s entry into a new phase of life without suggesting that he has escaped hardship. His medical degree offers a recognized identity, but not prosperity or authority in the neighborhood. The skeptical residents, the concierge’s prediction, and the later cases all test the difference between being officially qualified and being able to help.

Rancy also extends the book’s contrast between social performance and material conditions. A doctor’s nameplate and diploma promise competence, while the suburb’s crowded work routes, neglected housing, and difficult cases reveal how little those signs can alter the lives around him. Ferdinand’s practice gives him a place in the community, but its recurring crises make that place one of precarious service rather than secure success.