Immediately after Mikhail Afanasievich Bulgakov (1891-1940) finished his medical studies in 1916, he was ordered to run a rural hospital near Smolensk, Russia. His experience with more than 15 000 patients, seen within 1 year, is described in A Country Doctor's Notebook.1 In the story “The Speckled Rash, ” he masterly portrays his confrontation with syphilis. Prompted by intuition, he investigates the skin of a man who is about 40 years old: