John Raffles’s return to Stone Court turns a request for medical help into a crisis of conscience for Nicholas Bulstrode and a troubling clinical outcome for Tertius Lydgate. Raffles is seriously ill, receives Lydgate’s care under Bulstrode’s supervision, and dies before the doctor can understand why the case has taken a fatal turn. The episode binds medical uncertainty to Bulstrode’s concealed history and to his divided response to the survival of a man who can expose him.

Discovery and Medical Response

Caleb Garth tells Bulstrode that a stranger at Stone Court is very ill and needs a doctor. He identifies the man as Raffles, and Bulstrode’s visible shock betrays the significance of the name. Caleb explains that he encountered Raffles after he had left a coach and was walking beyond the turning from the toll-house. Recognizing that the sick man needed shelter, Caleb took him in his gig to Stone Court and then came to alert Bulstrode.

Bulstrode acts quickly: he sends a note for Lydgate and rides to Stone Court himself. When Lydgate arrives, Bulstrode names the patient as John Raffles, while hoping the physician will learn nothing more about their history. Lydgate examines Raffles, orders him to bed, and requires that he be kept as quiet as possible. His prognosis is cautious rather than reassuring: Raffles has a robust constitution, and the current attack need not prove fatal, but long-standing complications make the outcome difficult to judge.

Lydgate stresses that the patient must be watched, that his instructions must be followed firmly, and that he must not be given liquor if he asks for it. He believes the prescribed treatment may bring improvement within days, while recognizing that new complications could appear. His judgment reflects an established medical conviction: in cases of alcoholic poisoning, he rejects the prevalent practice of giving alcohol and repeatedly administering large doses of opium. He has acted on that view before, with favorable results, and plans to return the following morning.

Bulstrode’s Conflict and the Night at Stone Court

Lydgate’s medical instructions place Bulstrode in charge of the care, but the banker’s motives are not simple. He has exerted himself and spent money to help Raffles, yet the prospect of Raffles recovering also means the return of a threat to Bulstrode’s reputation. As the patient continues to live, Bulstrode grows irritable and privately longs for the release of Raffles’s death, even as he frames his fear in terms of his religious service and his desire to avoid disgrace. The narration makes clear that his wish is conflicted rather than openly declared: he has not fully disentangled his motives even in private prayer.

At six o’clock, after Raffles has slept only fitfully and repeatedly cried that he is sinking, Bulstrode begins administering opium according to Lydgate’s directions. After half an hour or more, he tells Mrs. Abel that he is unfit to continue watching and repeats the instructions for each dose. She has previously prepared and brought what Bulstrode ordered without knowing the details of Lydgate’s prescriptions. Now she asks what else she should do. Bulstrode tells her to offer soup or soda-water, to seek further directions from him if needed, and to call her husband for help if necessary.

Mrs. Abel believes the patient may die for want of support and recalls giving port wine and brandy to a former master she had nursed. She suggests that, if Bulstrode permits it, she could give Raffles the household rum. Bulstrode responds by handing her the key to the wine-cooler and directing her to the brandy there. The choice runs against Lydgate’s explicit instruction not to give Raffles liquor. The account establishes that brandy was made available, but does not establish what amount Raffles received or that it caused his death.

Death and Medical Uncertainty

After spending time in prayer early the next morning, Bulstrode learns from Mrs. Abel that Raffles has become deeply asleep. She says the change came gradually between three and four o’clock. Bulstrode recognizes that this is not restorative sleep but the approach of death. In Raffles’s room he sees a bottle containing some brandy and an almost empty opium phial. He puts the phial out of sight and carries the brandy bottle back downstairs, locking it away in the wine-cooler.

Lydgate arrives at half-past ten in time to witness Raffles’s final pause in breathing. He recognizes that the case has not followed the course he expected and watches in silence until he confirms that Raffles is dead. Bulstrode tells him that he did not keep watch during the night because he was worn out, that he left Raffles in Mrs. Abel’s care, and that he found the patient nearly in this condition before eight. Lydgate does not question him further. The narrative leaves the precise course of the night and the cause of death uncertain; neither the physician nor the reader is given grounds to conclude that a particular action caused the fatal result.

Aftermath and Narrative Significance

Lydgate is uneasy because Raffles’s death was unexpected, but he hesitates to imply that Bulstrode or the housekeeper’s ignorance or imprudence killed him. The patient is already dead, Lydgate acknowledges that he may be mistaken, and he has no clear basis for accusation. His professional judgment therefore meets the limits of what can be known after the fact. Medical responsibility and moral suspicion remain entangled without becoming a proven charge.

The men ride back to Middlemarch together and discuss other matters, including cholera and the Reform Bill, rather than the events of the night. Bulstrode mentions that Raffles should be buried in Lowick churchyard and says that, as far as he knows, the dead man has no connections apart from Rigg, who had described himself as unfriendly toward him. That practical arrangement contrasts with the unresolved history and suspicion Raffles leaves behind. The episode’s decisive reversal is not simply that a patient whom Lydgate thought might recover dies; it is that the death offers Bulstrode possible relief while leaving the truth of his conduct—and the cause of Raffles’s death—unsettled.