A white, speckled rash showed through the yellow colouring of his flanks and bulging chest. ‘Like stars in the sky,’ I thought to myself with a chill of fear as I bent down to his chest. Then I drew my eyes away from it and up to his face. Before me was a man of about forty with an untidy, ashen-grey beard and bright little eyes under swollen lids. To my great amazement I saw in those eyes a look of dignity and a sense of his own importance. Bored and indifferent, he blinked occasionally as he adjusted the belt of his trousers.

‘This is it—syphilis,’ I repeated grimly to myself. This was my first professional encounter with it, as I had been flung straight from university into a remote village.

I stumbled on this case of syphilis by chance. The patient had come to me complaining of a congested throat. All unawares, without a thought of syphilis, I had told him to get undressed, and only then did I see the speckled rash.

Putting all the symptoms together—his hoarseness, the sinister inflammation of his throat, the strange white patches on it and his mottled chest—I guessed at the trouble. My first, cowardly reaction was to rub my hands with a ball of sublimate of mercury. The minute it took to do this was poisoned by the anxious thought that he might have coughed on my hands. Then weakly and squeamishly I rolled a glass spatula in my hands and inspected my patient’s throat with it. Where should I put the spatula? I decided to place it on a wad of cotton wool on the window ledge.

‘Well now,’ I said, ‘you see … er … it seems … in fact it’s quite certain … you see, you have a rather unpleasant disease—you have syphilis …’

As soon as I had said this I felt awkward. I thought he might be frightened out of his wits. But not at all. He gave me a sidelong glance, rather as a hen looks up with her round eye when she hears a voice calling her. I was astonished to see mistrust in his round eye.

‘You’ve got syphilis,’ I repeated softly.

‘What’s that, then?’ asked the man with the speckled rash.

I had a brief, sharp mental vision of a snow-white ward at the university hospital, a lecture-theatre filled with rows of students’ heads and the grey beard of the professor of venereology … But I quickly came to myself and remembered that I was about a thousand miles away from the lecture-theatre and thirty miles from the nearest railway, and that my only light was a kerosene lamp … I could hear the dull buzz of voices coming from my numerous patients waiting their turn on the other side of the white door. Outside the window, night was steadily drawing in and the first winter snow was flying on the wind.

I made my patient take off more clothes and found a primary lesion which was already healing. I was no longer in any doubt, and felt the pride which invariably arose inside me whenever I made a correct diagnosis.

‘You can get dressed again,’ I said. ‘You’ve got syphilis! It is an extremely serious illness which affects the whole body. It will take a long time to cure.’

Here I faltered because—I swear it—I detected in that hen-like gaze astonishment clearly mixed with derision.

‘But I’m only a bit hoarse in the throat,’ said the patient.

‘Yes, I know. That’s why it’s gone hoarse, and that’s why you’ve got a rash on your chest. Have a look at your chest.’

He squinted at his chest. The ironic glint in his eyes did not fade.

‘Couldn’t you just give me something for my throat?’ he asked.

‘Why does he keep on like this?’ I thought somewhat impatiently. ‘I’m talking about syphilis and all he worries about is his throat!’

‘Look here,’ I continued aloud, ‘your throat is a minor matter. We’ll make your throat better too, but the most important thing is to get rid of the general disease. And the treatment’s going to take a long time—two years.’

At this the patient stared at me. I saw the verdict in his eyes: You’ve gone off your head, doctor!

‘Why so long?’ he asked. ‘How can it take two years? All I need is something to gargle for my throat.’

I saw red. I started to speak.