jump to navigation | jump to content

Travel Health Diaries

Observations in Travel Medicine

“Anything that walks, swims, crawls or flies with it’s back to the heavens is edible”
Ancient Chinese saying.

Some years ago, in the early-mid 1990’s, I had the honour & pleasure of working as the last medical officer employed at the Australian Embassy Medical Clinic in Beijing. The city was in rapid transition, the ‘flying pigeon’ bicycles still outnumbered cars, the hutong roofs were covered in cabbages in winter, & foreigners were not yet permitted to use local currency. It was very different to today’s Olympic city. The clinic, located in the Embassy, offered primary care to Australian diplomats, diplomats of friendly countries, & to Australian citizens living in or visiting China. Students & business people made up many of the regular patients. While fundamentally delivering general practice or assisting with consular cases, the job also required a preparedness to undertake diplomatic duties. (I was amused that a previous incumbent had been exhorted by his Ambassador to focus more on his medicine than his socialising!)

A significant proportion of work was travel medicine. Many new arrivals needed substantial advice about prevention of illness & endemic diseases, & a full range of routine & travel vaccines were in constant demand. Advice on malaria prophylaxis for regional travel was a common discussion. Clinical presentations encompassed the spectrum of general practice & common travel medicine presentations including fever, lethargy & GIT upsets. Amongst the spectrum of GIT illness, it was not uncommon to see diplomats or business people present with the direct effects of formal Chinese hospitality, often strange foodstuffs mixed with copious volumes of  spiritous ‘toasts to success & friendship’.  Hangovers were common.

One particular form of ‘hangover’ that I came to recognise was associated with the more expensive dinners. A peculiarity of Chinese entertainment was that the more expensive the meal, the more likely the food would be unusual, bizarre or of some endangered species. From time to time, last night’s diners would present with a ‘super hangover’ syndrome, associated with little or no alcohol ingestion. They would usually report a mix of symptoms from among nausea, vomiting, loose stool, shivering, shaking, weakness, myalgia, arthralgia, sweating, restlessness & commonly hallucinatory dreams. There was often an associated tachycardia & mild hypertension, dehydration & increased sweating evident on examination. Symptoms & signs would last 24-48 hours. The common thread I realised after seeing several similar cases, was that they had all eaten scorpions in the previous fancy meal.

Scorpion is still commonly served cooked at diplomatic & business dinners in China. Whole scorpions are stir fried in hot oil, cooked briefly for seconds, the heat is supposed to de-nature the toxins, the insects then served as a crunchy, exotic offering. It must be common that not all the toxins are rendered completely inactive & consumers get an unpredictable enteric dose of biologically active toxins. While scorpion is also still served as a common street food, where live scorpions are dropped into a spirit wine & when docile their stings & poison sacs are removed with scissors, this is not associated with reactions, presumably offering a lower hazard by removing the sting.

In China, the commonest scorpion is Mesobuthus martensii, which in the natural state can inject a mildly toxic venom which causes tachycardia & hypertension in humans. Human envenomation from this scorpion is a common medical problem in China as Mesobuthus martensii is commonly collected & bred for use in traditional medicine & food, & stinging common. It is generally this species on street-stall skewers, as well as gracing the exotic menu of much more expensive meals. Seasoned diplomats in China are adept at avoiding the weird, the endangered & the potentially hazardous foods, & many are particularly diplomatic when scorpion is on the menu!

While I had no specific antidote to my patients malady, they at least had learned a hard lesson on a hidden, albeit unusual, traveller’s hazard. & of course I was reminded also that not everything is ‘in the book’ & it is the experience of our travellers that brings the new insights & learning to the practice of travel medicine.

Suggested further reading (with thanks to Ken Winkel):

Bahloul M, Chaari A, Khlaf-Bouaziz N, Hergafi L, Ksibi H, Kallel H, Chaari A, Chelly H, Ben Hamida C, Rekik N, Bouaziz M. Gastrointestinal manifestations in severe scorpion envenomation. Gastroenterol Clin Biol. 2005 Oct;29(10):1001-5

Greg Elms. Snake Fang Salad: Culinary Travails in China ISBN: 9780646475806.

By Dr Tony, The Travel Doctor-TMVC