The narrator of the story, a former district doctor in Russia, reminisces about his frequent encounters with patients suffering from secondary syphilis ("the speckled rash"). The first case he diagnoses is a 40-year-old man seeking treatment for a sore throat. The doctor recommends the application of a bagful of mercury ointment once a day and a follow-up visit after 6 days, but the man never returns. The physician advises him that his wife needs to be examined also, but she is never seen in the clinic.

The doctor remembers many other cases of secondary syphilis in the community. Except for one young woman, patients seem to have little fear of the disease. Children and even entire families are infected. The physician decides to tackle the widespread venereal disease and to confront the rampant patient apathy in the district.

His weapons include mercury ointment, potassium iodide, Salvarsan (an arsenic compound) injections, harsh words, and warnings about the horrible effects of the disease if left untreated. He opens an inpatient unit to treat patients with syphilis. Now long-removed from that remote medical outpost, the narrator still wonders about the people living there.


Here is an intriguing portrait of a brand new physician on his first assignment in an isolated region of Russia. Treating as many as 100 patients some days and painfully aware of his inexperience, it is no wonder the young doctor is overwhelmed. In recalling the first patient with syphilis he sees in his practice in 1917, the narrator confesses, "Intuition prompted me. No need to rely on my knowledge; as a doctor only six months qualified, I had none" (65).

The narrator acknowledges the gratification of making a correct diagnosis but points out the occasional difficulty of announcing it to the patient. He quickly learns how hard it is to make the patients in his practice understand the severity of syphilis. Logic is insufficient so he resorts to scare tactics and even calls one patient a fool. Patient apathy and ignorance remain huge obstacles for the young physician: "I became convinced that syphilis was so fearful here precisely because it was not feared" (75).

Sandwiched between his 18-month stint as a general practitioner in a rural medical clinic and his abandonment of the practice of medicine to write full-time, Bulgakov worked in Kiev for about a year and a half, specializing in venereal diseases.


Translated from the Russian by Michael Glenny.

Primary Source

A Country Doctor's Notebook


Collins & Harvill

Place Published




Page Count