Syphilis prior to penicillin

Know syphilis in all its manifestations and relations, and all other things clinical will be added unto you

William Osler

American poet James L. White‘s first career was as a ballet dancer. Following this he studied English literature before teaching and living among Native Americans. He died of heart disease in 1981. ‘The Salt Ecstasies‘ is a collection of poems published following his death that includes:

Syphilis prior to penicillin

The United States Coast Guard had a
hospital for it in New York until 1952.
My doctor said if you knew syphilis,
you knew medicine because it perfectly imitated other diseases.
That in the last stages when it went rampant,
(beside their minds)
sailors would lose a nose or ear,
the disease mimicking leprosy.
And it was never cured or stabilized
so the sailors carried themselves as
weapons into every port.

The whores could never really tell either
for they were eaten with it too.
Those who knew their condition
often banded together
trying not to infect others with
a ‘taste for the mud’ as the French say.

They were a cavalier and doomed lot,
trying to hold back the dawn
in their foreign hotels,
where the night porters filled rooms
with verbena and gardenias
to hide the cooking smells of sulphur ointments.

At the last there were signs they couldn’t hide.
The motor nerves giving way so they walked with
odd flickering steps. That’s why Amelia and Rose Montana
would sit the evening through playing mah-jongg,
and the old sailors, Paul and James,
rarely asked the whores to dance.

While I don’t mean to detract in anyway from White’s poetic artistry, it is important (medically) to note that White’s ‘odd flickering steps’ refer to the ‘foot slapping’ gait of tabes dorsalis. This manifestation of syphilis is actually primarily caused by degeneration of the dorsal columns of the spinal cord. These nerves are not motor nerves, but transmit proprioceptive (position sense) information.

“Syphilis, which begins its pathological existence as a modest, inactive Hunterian chancre, soon enters upon a career that is unsurpassed for the inclusiveness and variety of its manifestations. There is no organ in the body, nor any tissue in the organs, which syphilis does not invade: and it is therefore manifestly difficult to speak, at least at all concisely, of the pathology of the disease; just as it is almost impossible to describe its clinical symptoms without mentioning almost every symptom of every disease known.William Osler (with JW Churchman) from ‘Syphilis. Modern Medicine: It’s Theory and Practice; 1907;3:436-521.’

William Osler; JW Churchman In: Syphilis. Modern Medicine: It’s Theory and Practice; 1907;3:436-521.

Old letter

Literary Medicine


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

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