Dashes are used to add emphasis or change a topic, as they can either give more importance to an idea or just interrup the idea with another one.
Ellipsis is used to remove unwanted parts of a long quotation and is mostly represented by three consecutive periods. It helps omit unnecesary elements within a sentence.
Commas are used to separate clauses, phrases, coordinating adjectives and non-essential words. Commas usually indicate pauses and they are used to separate ideas within a sentence.
The sentence that suggest that doctors, like lawyers are part of superficial middle-class world of nineteenth century Rusia is:
The doctor put on just the same air towards him as he himself put on towards an accused person.
