A melodramatic tale of a doctor searching for a cure to a mysterious affliction tormenting San Francisco. His sinister assistant, Surama, "helps" him. Adolphe de Castro was an author much older than Lovecraft, best known for his acquaintance with Ambrose Bierce (whom he tried to exploit in various ways). When he met H.P. Lovecraft, he was still aspiring to be a writer, and things were going so poorly that he sought assistance. De Castro offered Lovecraft two options: either editing extensive memoirs of his acquaintance with Bierce or a collection of stories titled "In the Confessional." The Providence writer chose the latter, specifically to revise one of the stories in the collection. The chosen piece was titled "A Sacrifice to Science."
