MONTEZUMA'S REVENGE
1
30 terested in research, and not only on the periphery; at the postgraduate Institute of Psychiatry in London, the number of psychiatrists obtaining M.D. or M.PHIL. degrees fell from 20 in 1971/72 to 6 in 1974/75.70 This widespread decline is all the more remarkable since it followed a decade which saw the establishment not only of many university departments of psychiatry but also of the Royal College of Psychiatrists. But perhaps this is where we should look for the origins of the decline. There are a limited number of people of outstanding merit in psychiatry, and many of these are now pre- occupied by university and college politics to the exclu- sion of research. There are further hazards looming ahead. As in other specialties, most junior research-workers are not eligible for overtime payments, and are therefore at a financial disadvantage to their contemporaries in clinical psych- iatry. They may soon find themselves at a similar disad- vantage in terms of specialist registration unless the Joint Committee on Higher Psychiatric Training amends its first report. 71 This asserts that four years of higher training (i.e., postM.R.c.PSYCH.) are necessary for specialist registration, and that only one year of full- time research can be counted towards this. Such a regu- lation would seriously deter young psychiatrists from taking up research. Fortunately, both trainees and direc- tors of research units have protested and the committee may yet change its mind. However, with all these black clouds on the horizon, those interested in psychiatric research should be grateful to the Wellcome Trust for its offer of a silver lining. MONTEZUMA’S REVENGE BETWEEN a quarter and a half of visitors to Mexico are struck down by "Montezuma’s revenge", the Mexi- can equivalent of travellers’ diarrhoea ; and a medical conference in Mexico City provided an excellent oppor- tunity for a prospective study of the clinical, epidemiolo- gical, and laboratory aspects of the infection.72 True to form, almost half of those 121 physicians and accom- panying relatives (mostly from the U.S.A.) who agreed to take part in the survey developed diarrhoea, abdomi- nal cramps, nausea, and associated symptoms between 12 hours after arrival in Mexico and 5 days after depar- ture. In all cases stool swabs taken up to 3 days before arrival had been negative for pathogens. Montezuma must have had a good laugh at this, for the doctors attending the conference were all gastroenterologists, who might reasonably have been expected to be able to avoid such minor but inconvenient afflictions of the gastrointestinal tract. Diarrhoea was associated in 45% of cases with entero- toxigenic Escherichia coli, and other potential pathogens included salmonellae, Shigella sonnei and S. flexneri, Vibrio parahcemolyticus, Entamcuba histolytica, Giardia lamblia, and the human reovirus-like agent. In 37% of 70. Institute of Psychiatry, Report for 1974-75. University of London, 1976. 71. Joint Committee on Higher Psychiatric Training: First Report, 1975. (Obtainable from the Royal College of Psychiatrists). 72. Merson, M. H., Morns, G. K., Sack, D. A., and others New Engl. J. Med. 1976, 294, 1299. affected subjects no pathogens were found, but in some of these cases the negative findings could be attributed to the use of antibiotics. The identification of several pathogens does not necessarily point to a causal relation- ship, especially where more than one organism is iso- lated from a single specimen; nevertheless, the results suggest that a variety of organisms must have contri- buted to the infection, even though the individual cul- prits (apart from enterotoxigenic E. coli) could not be positively identified. Drinking tap-water and iced beverages is usually thought to be the surest way of acquiring travellers’ diarrhoea in places where sanitary and general living conditions are less than ideal, but in this study visitors who drank only bottled water fared no better than their less cautious colleagues. In fact, they all did rather badly, and the dietary indiscretion which had the most unfortunate consequences (and in which, presumably, both groups of drinkers indulged) was the consumption of salads containing raw vegetables: this was strongly as- sociated with infection by enterotoxigenic E. coli. It would still seem wiser, therefore, to stick to freshly cooked food. Medications such as opiates and diphenoxy- late hydrochloride with atropine, which were taken by some of the participants, may actually prolong some forms of infective diarrhoea 72 and are best avoided except in severe cases. RETIREMENT OF DR DOUGLAS-WILSON DR IAN DoUGLAS-WILSON, Editor of The Lancet since 1965, retired on June 30. His successor is Dr Ian Munro; and the Deputy Editors are Dr Robin Fox and Mr David Bharn Among the presentations to Ian and Betty Douglas-Wilson was the original of this new drawing by Geoffrey Fletcher of the Lancet office at 7 Adam Street.
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Transcript of MONTEZUMA'S REVENGE
30
terested in research, and not only on the periphery; atthe postgraduate Institute of Psychiatry in London, thenumber of psychiatrists obtaining M.D. or M.PHIL.
degrees fell from 20 in 1971/72 to 6 in 1974/75.70 Thiswidespread decline is all the more remarkable since itfollowed a decade which saw the establishment not onlyof many university departments of psychiatry but also ofthe Royal College of Psychiatrists. But perhaps this iswhere we should look for the origins of the decline.There are a limited number of people of outstandingmerit in psychiatry, and many of these are now pre-occupied by university and college politics to the exclu-sion of research.
There are further hazards looming ahead. As in otherspecialties, most junior research-workers are not eligiblefor overtime payments, and are therefore at a financial
disadvantage to their contemporaries in clinical psych-iatry. They may soon find themselves at a similar disad-vantage in terms of specialist registration unless the
Joint Committee on Higher Psychiatric Trainingamends its first report. 71 This asserts that four years ofhigher training (i.e., postM.R.c.PSYCH.) are necessary forspecialist registration, and that only one year of full-time research can be counted towards this. Such a regu-lation would seriously deter young psychiatrists fromtaking up research. Fortunately, both trainees and direc-tors of research units have protested and the committeemay yet change its mind. However, with all these blackclouds on the horizon, those interested in psychiatricresearch should be grateful to the Wellcome Trust for itsoffer of a silver lining.
MONTEZUMA’S REVENGE
BETWEEN a quarter and a half of visitors to Mexicoare struck down by "Montezuma’s revenge", the Mexi-can equivalent of travellers’ diarrhoea ; and a medicalconference in Mexico City provided an excellent oppor-tunity for a prospective study of the clinical, epidemiolo-gical, and laboratory aspects of the infection.72 True toform, almost half of those 121 physicians and accom-panying relatives (mostly from the U.S.A.) who agreedto take part in the survey developed diarrhoea, abdomi-nal cramps, nausea, and associated symptoms between12 hours after arrival in Mexico and 5 days after depar-ture. In all cases stool swabs taken up to 3 days beforearrival had been negative for pathogens. Montezumamust have had a good laugh at this, for the doctorsattending the conference were all gastroenterologists,who might reasonably have been expected to be able toavoid such minor but inconvenient afflictions of the
gastrointestinal tract.Diarrhoea was associated in 45% of cases with entero-
toxigenic Escherichia coli, and other potential pathogensincluded salmonellae, Shigella sonnei and S. flexneri,Vibrio parahcemolyticus, Entamcuba histolytica, Giardialamblia, and the human reovirus-like agent. In 37% of
70. Institute of Psychiatry, Report for 1974-75. University of London, 1976.71. Joint Committee on Higher Psychiatric Training: First Report, 1975.
(Obtainable from the Royal College of Psychiatrists).72. Merson, M. H., Morns, G. K., Sack, D. A., and others New Engl. J. Med.
1976, 294, 1299.
affected subjects no pathogens were found, but in someof these cases the negative findings could be attributedto the use of antibiotics. The identification of severalpathogens does not necessarily point to a causal relation-ship, especially where more than one organism is iso-lated from a single specimen; nevertheless, the resultssuggest that a variety of organisms must have contri-buted to the infection, even though the individual cul-prits (apart from enterotoxigenic E. coli) could not bepositively identified.
Drinking tap-water and iced beverages is usuallythought to be the surest way of acquiring travellers’diarrhoea in places where sanitary and general livingconditions are less than ideal, but in this study visitorswho drank only bottled water fared no better than theirless cautious colleagues. In fact, they all did rather
badly, and the dietary indiscretion which had the mostunfortunate consequences (and in which, presumably,both groups of drinkers indulged) was the consumptionof salads containing raw vegetables: this was strongly as-sociated with infection by enterotoxigenic E. coli. Itwould still seem wiser, therefore, to stick to freshlycooked food. Medications such as opiates and diphenoxy-late hydrochloride with atropine, which were taken bysome of the participants, may actually prolong someforms of infective diarrhoea 72 and are best avoided exceptin severe cases.
RETIREMENT OF DR DOUGLAS-WILSON
DR IAN DoUGLAS-WILSON, Editor of The Lancet since1965, retired on June 30. His successor is Dr Ian
Munro; and the Deputy Editors are Dr Robin Fox andMr David Bharn
Among the presentations to Ian and Betty Douglas-Wilsonwas the original of this new drawing by Geoffrey Fletcher ofthe Lancet office at 7 Adam Street.
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