‘Nothing?’ the woman asked hoarsely. ‘Nothing?’ Her eyes began to shine and her cheekbones flushed with colour. ‘But say it begins?’
‘I can’t understand it myself,’ I said under my breath to Pelagea Ivanovna. ‘According to what she’s told us, she ought to be infected. But there’s nothing.’
‘Nothing at all,’ Pelagea Ivanovna repeated after me.
We spent another few minutes whispering about dates and various intimate matters and I told the woman she would have to come regularly to the hospital.
As I looked at her then I saw that she was crushed. Hope had crept in and almost immediately vanished. She burst into tears and went away like a dark shadow. From that time on she lived under a sword of Damocles. Every Saturday she came silently to my surgery. She lost a lot of weight and her cheekbones protruded more sharply, her eyes became sunken and encircled by shadows. She would untie her shawl with a habitual movement and we would all three go to the ward to examine her.
The first three Saturdays passed and we found nothing. Then gradually she started to recover. Her eyes regained their sparkle, her face livened and the drawn look began to smooth out. The odds rose in our favour. The danger was passing. On the fourth Saturday I spoke with certainty. I could count on a roughly ninety per cent chance of a favourable outcome. The first twenty-one-day period was well past. There remained the remote possibility that the chancre might develop extremely late. That period finally passed too, and one day, as I threw the shiny mirror away into the basin, having felt her glands for the last time, I said to the woman:
‘You are no longer in any danger. You needn’t come any more. You have been lucky.’
‘I’m all right?’ she asked in an unforgettable voice.
‘Yes, you’re fine.’
I lack the power to describe her face. I remember that she bowed low from the waist and went out.
She did, however, come once more. She was holding a bundle in her arms—two pounds of butter and two dozen eggs. After a terrible inner struggle, I accepted neither. Being so young, I felt very proud of this. But later, when I had to go without food in the years immediately after the revolution, I often thought of the kerosene lamp, those dark eyes, and the golden slab of butter marked with fingerprints and with droplets of water oozing out of it like dew.
But why should I recall this woman, condemned to four months of terror, when so many years have passed since then? There is a reason. For she was my second suspected syphilis patient and I later devoted the best years of my life to venereal diseases. The first was the man with the speckled rash on his chest. She was the second, and the only exception, because she was afraid: the only one to remain in my memory from all the work that we four (Pelagea Ivanovna, Anna Nikolaevna, Demyan Lukich and myself) did by the light of those kerosene lamps.
While she was going through her agonizing Saturday visits as if waiting for her execution, I started investigating the disease. The long autumn evenings and the hot tiled stove produced such warmth and stillness that I felt all alone in the world with my lamp. Somewhere outside life was raging like a storm, but here only the slanting rain could be heard tapping at my window, then turning imperceptibly into soundless snow. I sat for long hours studying the last five years’ records of the out-patients’ surgery. The names of people and villages passed before me in their thousands and tens of thousands. I was looking for syphilis in these columns of people and I came across it often. There were rows of boring, routine entries like ‘Bronchitis’, ‘Laryngitis’, and others … But here it was: ‘Lues III’. And in the margin in the same bold hand:
‘R. Ung. hydrarg. ciner. 3.0 D.t.d.’
That was it—the black ointment.
And off I would go again. Again the bronchitis and catarrh would dance before my eyes and then suddenly there would be a break … ‘Lues’ again.
The more frequent entries, in fact, were of secondary syphilis. Tertiary cases occurred less often, and then potassium iodide was boldly written in the ‘Treatment’ column.
The more I read the old mildew-smelling folios of the outpatients’ register which I had retrieved from the attic, the more light filtered into my inexperienced head. I began to understand some appalling things.
Where, for instance, were the entries for primary lesions? Somehow there did not seem to be any. There was hardly a single one among a thousand names. What could this mean?
‘This means,’ I said in the dark to myself and to the mouse that was nibbling the backs of the old books on the shelves, ‘this means that the people here have no conception of syphilis and the lesions don’t frighten them. I see. And then they heal spontaneously, leaving a scar. And is that all? No, that’s not all! For then secondary syphilis, the vicious stage, sets in. Semyon Khotov, aged 32, will get a sore throat and oozing papules and then he will go to the hospital and he will be given the grey ointment …’
The light cast by my lamp formed a circle on the table and the chocolate-coloured woman lying on the bottom of the ashtray had vanished under the pile of cigarette butts.
‘I’ll find this Semyon Khotov. Let’s see now …’ The slightly yellowing pages of the out-patients’ register crackled faintly. On 17 June 1916 Semyon Khotov was given six bags of mercury ointment, invented long ago to heal people like him. I can imagine my predecessor saying to Semyon as he handed him the ointment:
‘Semyon, when you’ve rubbed it on six times, wash it all off and come and see me again. Do you hear me, Semyon?’
Semyon bowed, of course, and thanked the doctor in a hoarse voice. Well, in another ten to twelve days he is bound to appear in the book again. Let’s see … Cigarette smoke, rustle of pages. Hmm … not a sign of him! He’s not there ten days later, nor twenty. He’s not there at all. Poor Semyon Khotov. In all likelihood the speckled rash has vanished like the stars at dawn and the condylomata have dried up. And Semyon will surely perish. I shall probably see him at my surgery with gummatous lesions. Is the bridge of his nose still intact? Are the pupils of his eyes symmetrical? Poor Semyon!
But whom have we here? Not Semyon Khotov, but Ivan Karpov. Nothing surprising in that. Why shouldn’t Karpov fall ill? Yes, but wait a minute—why has he been prescribed calomel with sugar and milk in small doses? The reason is that Ivan is two years old! And he is suffering from ‘Lues II’. That fateful ‘II’! He was covered in a rash when his mother carried him in and he struggled out of the doctor’s strong grasp. It is all quite clear.
‘I know, I can guess. Now I realise where the two-year-old had the primary lesion which always precedes the secondary stage. It was in the mouth! He got it from his spoon.’
What lessons there are to be learned from the backwoods, from the peace and quiet of country life! Yes, the old register has many interesting things to tell the young doctor.
Above Ivan Karpov there was written:
‘Avdotya Karpova, aged 39.’
Who was she? Oh, I see. She was Ivan’s mother. She was carrying him as he cried.
And below Ivan Karpov:
‘Maria Karpova, aged 8.’
Who’s that? His sister. More calomel …
The whole family is there. A family. There’s only one member missing—Karpov, 35 to 40 years old. His first name is not known. Was it Sidor, Pyotr …? Anyway, it doesn’t matter.
Ah, here’s the document. Now I see. He probably came back from the damned war and did not ‘confess’, or maybe he did not know that he needed to. Then he went away again. And that’s how it began. After Avdotya, Maria; after Maria, Ivan. They used the same soup bowls and towels.
Here’s another family. And another. There’s an old man, seventy years old. ‘Lues II’. An old man. What had he done wrong? Nothing. He had simply shared a mug; non-sexual contagion. It was daylight outside, with the whitish light of an early December dawn. I had sat up the whole lonely night poring over the hospital records and the splendid German textbooks with their colourful illustrations.
On my way to the bedroom
I mumbled through a yawn:
‘I’m going to fight this thing.’
In order to fight it I had to see it. And it was not long in coming. A sleigh road had been laid, and on some days as many as a hundred patients came to see me. The day would begin in cloudy white light and end with a black haze into which the last sleighs would disappear with a mysterious hiss.
It came in many insidious guises. It would take the form of whitish lesions in an adolescent girl’s throat, or of bandy legs, or of deep-seated, indolent ulcers on an old woman’s yellow legs, or of oozing papules on the body of a woman in her prime. Sometimes it proudly displayed itself on the forehead as a crescent-shaped ‘crown of Venus’, or, as an indirect punishment for the sins of their fathers, on children with noses that were the shape of a Cossack’s saddle. And there were other times when it simply escaped my attention. I was only just out of the lecture-theatre, after all!
Unaided and alone I thought it all out for myself. Somewhere the disease was lurking in people’s bones and in their minds. I learned a great deal.
‘They told me to rub some stuff on.’
‘Was it black ointment?’
‘That’s it, sir, black ointment.’
‘On alternate limbs? On the arm one day, on the leg the next?’
‘So he did. How did you know?’ (flatteringly).
How could I fail to know? It was all so obvious. Just look at that gumma!
‘Were you in great pain?’
‘I should think so! Howled more than a woman having a baby.’
‘Uhuh … did you have a sore throat?’
‘That’s right. I had a sore throat. Last year.’
‘I see. Did Leopold Leopoldovich give you the ointment?’
‘That’s right. Black as my boot, it was.’
‘Well, you made a bad job of rubbing it on. You didn’t do it properly …’
I wasted countless kilograms of grey ointment. I prescribed masses of potassium iodide and used a great deal of strong language. I managed to persuade a few to come back after they had rubbed on the first six bagfuls of ointment. A few of these actually underwent the initial course of injections, although most did not complete them. The majority slipped through my fingers like sand in an hourglass, and I could not go looking for them out in the snowbound darkness. I became convinced that syphilis was so fearful here precisely because it was not feared. And that is why, at the beginning of these reminiscences, I introduced the woman with the dark eyes. I remember her with a kind of heartfelt respect for her very fear. But she was the only one!
As I matured, I grew more single-minded and sometimes even sullen. I dreamed of when my spell in that job would be over and I could return to the university town, where it would be easier to fight syphilis.
On one such gloomy day a very good-looking young woman came to my surgery at the hospital holding a swaddled baby in her arms. Two toddlers stumbled in after her, hindered by their oversized felt boots as they hung on to the blue skirt which flared out from under her sheepskin jacket.
‘The children have suddenly come out in a rash,’ the pink-cheeked woman said gravely.
Cautiously I touched the forehead of the little girl who was holding on to the skirt. She hid herself in its folds and vanished without trace. I fished out the fat-faced little boy from behind the other side of the skirt and felt him too. Both their foreheads felt quite normal.
‘Would you undress the baby, my dear?’
She unwrapped the baby girl. Her naked little body was spattered with a starry rash like the sky on a frosty night. It was covered from head to foot in roseola and oozing papules. Vanka, the little boy, suddenly struggled out of my grip and started to howl. Demyan Lukich came to help me.
‘It’s a chill, isn’t it?’ said the mother, looking at me with a serene expression.
‘A chill!’ Lukich growled and made a grimace of pity and disgust. ‘The whole damn district of Korobovo has caught this sort of chill.’
‘What’s it from?’ the mother asked while I inspected her mottled sides and chest.
‘Get dressed,’ I said.
Then I sat down at the desk, laid my head on my hand and yawned (she was one of the last that day; she was number ninety-eight). Then I said:
‘Both you, my dear, and your children are very, very ill. This is a dreadful, dangerous disease. You must start a very long course of treatment at once.’
What a pity that words are so inadequate to describe the incredulity in the woman’s bulging eyes. She turned the baby over like a log in her arms, stared dully at its legs and asked:
‘Where does it come from?’
And she gave a crooked grin.
‘That’s not the point,’ I replied, lighting my fiftieth cigarette that day. ‘You should be asking what will happen to your children if you don’t have them treated.’
‘Nothin’ at all, that’s what,’ she answered and started wrapping the baby in its swaddling clothes.
My watch lay on the table in front of me. As far as I remember, by the time I had been speaking for three minutes the woman burst into sobs. I was very glad of these tears, brought on by my intentionally cruel and frightening words, because it was only thanks to them that I was able to say what I said next:
‘So they’re staying. Demyan Lukich, put them in the annexe, please. I shall go to town tomorrow and get permission to open an in-patient section for syphilitics.’
The feldsher showed a lively interest:
‘But doctor—(he was a great sceptic)—how shall we manage on our own? What about the medicines? We can’t spare any nurses … and who’s going to do the cooking? Have you thought about the crockery, the syringes?’
But I shook my head obstinately and answered:
‘I’ll see to all that.’
A month passed.
The three rooms of the snow-covered annexe were lit by lamps with tin shades. The beds were made up with torn old sheets. There were only two syringes—a small one-gramme syringe and a five-gramme venereal one. In other words, it was pitiful, snowbound poverty. But one syringe was proudly kept separate—the instrument with which, inwardly dying of fear, I had already administered several difficult and unfamiliar injections of the new Salvarsan.
More than that: I was feeling much relieved, as seven men and five women were lying in the annexe, and each day their speckled rashes were melting before my eyes.
It was evening. Demyan Lukich was holding a small lamp and casting its light on the shy little boy, Vanka, whose mouth was smeared with semolina. But the boy no longer had a rash. It was balm to my conscience as all four of them passed under the lamp.
‘I think I’ll get myself discharged tomorrow,’ said the mother, tucking in her blouse.
‘No, you mustn’t go yet,’ I replied. ‘You must still have another course of injections.’
‘I won’t agree to it,’ she retorted. ‘I’ve got too much to do at home. Thank you for your help, but please discharge me tomorrow. We’re better now.’
Our conversation gradually became so heated that we both lost our tempers. It ended like this:
‘Do you know what you are?’ I said, feeling my face redden. ‘You’re a … fool!’
‘What sort of language is that? Do you always swear at your patients?’
‘You’re much worse than a fool! You’re not that, you’re a …! Take a look at your Vanka! Are you trying to kill him? Well, I’m not going to let you!’
She stayed another ten days.
Ten days! Wild horses could not have kept her longer. But believe me, my conscience was clear and I was not even worried about calling her a fool. I’m not sorry. What is swearing in comparison with the speckled rash!
Many years have passed since then. Fate and the turbulent years have put a long distance between me and the snow-covered annexe. What is happening there and who is there now? I am certain it has been improved. The building has probably been whitewashed and there are new sheets. There is no electricity, of c
ourse. It is just possible that as I write these lines a young head is bending over a patient’s chest. The yellow light from a kerosene lamp is shining on a yellow leg.
Greetings, dear colleague!
THE BLIZZARD
Now howls the blizzard like a wolf,
Now, child-like, whimpers, sobs and weeps.
ACCORDING TO THE OMNISCIENT AKSINYA, THE whole story began when a clerk called Palchikov, who lived in Shalometyevo, fell in love with the daughter of an agronomist. His was a flaming passion, which consumed the poor wretch’s heart. He drove into the nearby town of Grachyovka and ordered himself a suit. The effect was dazzling, and it may well be that the grey stripes of that clerk’s new trousers sealed the luckless man’s fate. The agronomist’s daughter agreed to become his wife.
I had acquired such fame after amputating the leg of the girl who fell into a flax-brake that I almost expired under the burden of my reputation. Every day a hundred peasants would drive up the sleigh track to attend my surgery. I stopped having lunch. Arithmetic is a cruel science: assuming that I spent no more than five minutes on each patient … five!… then five hundred minutes equals eight hours and twenty minutes—without a break, please note. Apart from that I had a ward for forty inpatients. And I also did operations.
In short, when I left the hospital at nine o’clock in the evening I had no desire to eat, drink or sleep. My only wish was for no one to call me out to a confinement. And in two weeks I was dragged out at night along that sleigh track five times.
A film of liquid clouded my eyes and a vertical fold, like a worm, appeared above the bridge of my nose. At night through a dim haze I dreamed of failed operations and exposed ribs, of my hands covered in human blood, and I would wake up in a cold sweat despite the heat from my tiled stove.