I
118 15 January 1966 Leading Articles
introducing young people to the hills, and in addition many
local authorities as well as the Central Council for Physical
Recreation run courses both in mountain activities and in
rock-climbing. But large numbers of complete novices do
go hill-walking or rock-climbing entirely on their own, ill-
equipped and incompetent. As a result the numbers of
emergencies have greatly increased and they put a great
strain on the rescue services, especially during the major
public holidays. Were it not for the help of the National
Health Service and the Red Cross and St. John organiza-
tions in providing much of the equipment used, and of the
R.A.F. Mountain Rescue Service in giving their practical
assistance so generously, many injured or exhausted climbers
who now live to tell the tale would probably not have been
brought down alive.
In economic terms mountain rescue is becoming increasingly
expensive, partly because of the greater numbers of accidents,
partly because equipment is becoming more sophisticated.
Many teams are now being provided with radiotelecommuni-
cation apparatus-an almost essential item of equipment when
large areas of rough ground have to be searched for missing
climbers. The cost of equipping a team with an adequate
number of sets is considerable, and although money can be
and is raised by local effort and enthusiasm it seems reasonable
to suggest that people whose survival has depended on the
efficiency of the rescue services should be asked to make
some contribution to their cost. If practicable this would
Food-poisoning
A " General Practitioners' Memorandum on Food Poisoning,"
prepared by the Standing Medical Advisory Committee for
the Central Health Services Council and the Ministry of
Health, was issued on 30 December.1 It defines the several
conditions covered by this rather unsatisfactory term, giving
their incubation periods and principal symptoms. They
include those due to the presence of adventitious chemical
poisons in food, three varieties due to bacterial toxins formed
in the food (staphylococcal, Clostridium welchii, and Cl.
botulinum), and one straightforward infection-that due to
a salmonella of the food-poisoning type, as distinct from the
species causing enteric fever. Two other conditions are
described from which these have to be distinguished-
bacillary dysentery and epidemic nausea and vomiting2
(" winter vomiting disease "). The memorandum also
mentions that the term food-poisoning, for purposes of the
notification which has been required since 1938, does not
include infections such as enteric fever and dysentery, which
are " notifiable in their own right." The memorandum com-
plains that notification has been far from complete. Since
one reason for that may be some understandable confusion
about what the term food-poisoning covers, the memo-
randum should help to dispel this.
Some interesting figures are given of the incidence of this
group of diseases. The total number of outbreaks steadily
rose from 2,428 in 1949 to 8,961 in 1955; they remained
at almost as high a level until 1959, but fell progressively
to 4,465 in 1963. No explanation is offered for the startling
increase in the early 1950s, though several suggest themselves.
Possible causes of it include the importation of a greater
amount and variety of contaminated foodstuffs, changes in
&WBRI
seem to be preferable to seeking aid from Treasury funds.
How may mountain accidents be avoided ? It is worth
noting that mountaineering, whether easy hill-walking or
severe rock- or snow-climbing, has natural hazards the facing
and overcoming of which are part of the immense satisfac-
tion the sport can give. Thus the risk of accident is ever
present. But the climber should be adequately trained and
equipped both to avoid unnecessary risk and to deal with
emergencies, particularly sudden changes of weather. He
should have enough common sense and emotional stability
to enable him to relate the conditions to his own capabili-
ties and to decide dispassionately on his course of action
in any given circumstances. By training and experience
the majority of climbers eventually become competent in
all these respects, and administrative measures designed to
reduce their freedom of action would be both superfluous
and unwelcome. One way in which a little effort may
yield notable rewards is the raising of the standard of
competence of leaders of parties of young people. Such
groups do seem unduly liable to get into difficulties, and this
must reflect on the quality of the people in charge. All too
often, it seems, this responsibility is taken lightly, with some-
times fatal consequences. The recently instituted training
courses for youth leaders, teachers, and others who may have
to take young people on the hills, provided they are widely
publicized, should have a beneficial effect on mountain safety
in this country.
methods of handling food in communal eating places, and
perhaps better diagnosis owing to the extension of the Public
Health Laboratory Service. Subdivision into general and
family outbreaks shows the former to have been slightly
more numerous until 1954, when those confined to the family
went ahead and are now more than twice as common.
Classification by aetiology shows Salmonella infections pre-
ponderating in family outbreaks, together with a high
proportion of "unknowns." General outbreaks are more
nearly evenly distributed among the aetiological classes, and
include most of those due to Cl. welchii.
Brief descriptions are given of how food comes to be
contaminated with the causative bacteria. These might with
advantage have been expanded somewhat. It is rather too
sweeping to say that " Salmonellae are found in all foods of
animal origin-meats, meat products, soups, milk, eggs...."
In home-killed meat they are unlikely to be present except
after emergency slaughter, and for eggs a distinction should
be drawn between those of hen and duck, and between shell
egg and imported canned or dried egg. Mice and rats,
imported coconut powder, and human carriers might also
have been mentioned. The memorandum rightly emphasizes
that Cl. welchii food-poisoning is almost wholly the result
of cooking meat the day before it is served and failing to
refrigerate it adequately overnight,' but it might have added
that this almost ubiquitous organism is incapable in its
ordinary form of causing food-poisoning. The form that
causes it is a subvariety of type A, distinguished by being
non-haemolytic and possessing greater resistance to heat; it
is fortunately not, like the normal type A, an inhabitant of
I Food
Poisoning. Ministry of
2 Brit. med. 7., 1965, 2, 953.
Health, November 1965.
3 Ibid.. 1960. 1. 711.
15 January 1966 January Leadingb Articles
every human bowel. The expression " faulty handling " as
an explanation of staphylococcal food-poisoning is a little
ambiguous, for the fault lies not so much in the method of
manipulation as in the fact that the operator is a carrier,
or even-as in one famous outbreak-has a whitlow on his
finger. The association of inferior cheese and of canned peas
with this kind of food-poisoning also deserves mention.
The memorandum gives useful practical instructions on
how to ascertain the cause of an outbreak of food-poisoning
and to limit its spread, and concludes with a homily on food
hygiene, both commercial and domestic. Particular emphasis
is laid on the necessity for regular and early notification in
order that investigations may be started before essential
materials have been lost.
Pink Spot in Schizophrenia
Among the several biochemical processes which have been
examined as possible links with schizophrenia' an abnormality
of adrenaline metabolism has attracted attention since it was
proposed in 1952.2 3 The hypothesis was based originally
on the similarity between the chemical formulae of mescaline
and adrenaline. This suggested that schizophrenics might
produce abnormal metabolites of adrenaline similar to mesca-
line in their chemical structure and psychotomimetic proper-
ties. An interesting metabolite of mescaline is the compound
3,4-dimethoxyphenylethylamine (D.M.P.E.), a dimethylated
derivative of dopamine which Friedhoff and van Winkle
first reported as forming a " pink spot " chromatographically
in the urine of schizophrenic patients but not in the urine of
normal people.
This claim, which points to a disorder of biological trans-
methylation, has since been examined in other centres with
conflicting results.Y'8 Recently R. E. Bourdillon and his
colleagues at the University of Liverpool have tried to
evaluate the putative association more closely.9 Using two
different methods of assessment, they have tested for the
presence of the pink spot among psychiatric in-patients,
among close relatives of schizophrenics, and among mentally
normal people. The published results are striking. The
pink spot was identified in the urine of only one of the 391
mentally normal people. Clinical and biochemical assess-
ments were made independently by two pairs of observers
on two separate groups of psychiatric in-patients. In one
sample of 101 cases the pink spot was deemed to be present
in 46 out of 84 schizophrenics, and absent in all 17 non-
schizophrenics; in the other sample of 296 cases only 1 out
of 77 non-schizophrenics showed the pink spot, while it was
detected in the urine of 27 of the remaining 219 patients who
were regarded as suffering from schizophrenia or schizo-
phreniform syndromes. Further, the schizophrenic patients
in the smaller sample were subdivided clinically into " para-
Brit. med. J7., 1963, 1, 695.
2 Osmond, H.,
and Srnythies, J.,.Y. ment. Sci., 1952, 98, 309.
8 Harley-Mason, J., ibid., 1952, 98, 313.
'Friedhoff, A. J., and van Winkle, E., Nature (Lond.), 1962, 194, 897.
& Takesada, M., Kakimoto, Y., Sano, I., and Kaneko, Z., ibid., 1963, 199,
203.
Perry, T. L., Hansen, S., and Macintyre, L., ibid., 1964, 202, 519.
?Faurbye, A., and Pind, K., Actafschioa. scand., 1964, 40, 540.
'Kuehl, F. A., et al., Nature (Lonf), 1964, 203, 154.
Bourdillon, R. E., Clarke, C. A., Ridges, A. P., Sheppard, P. M., Harper,
P., and Leslie, S. A., ibid., 1965, 208, 453.
Schneider, K., Fortschr. Neurol. Psychwat., 1957, 25, 487.
'Kety, S. S., Int. Psj-chiot., 1965, 1, 4(C9.
12 Symposium on Yt.
Amine Metabolism in Fchizcphrenia, Atlmntic City,
April 1965 (in press).
MEDICAL IJ
MEDICAL~~~ 119
noid " and " non-paranoid " groups, and also according to
whether or not they had exhibited one or more of Karl
Schneider's so-called first-rank symptoms.10 Relating the
chemical data to these subgroups, the authors conclude:
" When the individuals are classified as being Schneider posi-
tive and non-paranoid this sub-class has a significantly higher
incidence of the pink spot than does any other group (83.3 ±
5.75%). Thus to predict the presence of the pink spot the
double classification is the most efficient." The trend in the
larger sample was similar, but the use of a more specific bio-
chemical technique resulted in a substantially smaller estimate
of patients excreting urine with the pink spot. The pink
spot was absent from the urine of 20 close relatives of three
schizophrenic patients.
Here, then, is evidence in favour of another remarkable
addition to the biochemical theories of schizophrenia. Investi-
gators in this field, however, have learnt to tread warily round
the many pitfalls that beset it, reviewed recently by S. S.
Kety. Discussing the possible role of transmethylation,
Kety cautiously refers to " some interesting findings com-
patible with provocative hypotheses but the findings and the
hypotheses are still in the earliest stages of evaluation." The
broad epidemiological approach of the Liverpool workers has
carried the process of evaluation a stage further, but, as they
concede, there are unresolved problems pertaining to both
their methods and the interpretation of their data. The results
of cognate work now in progress at several centres'2 will be
awaited with interest.
Methyldopa in Hypertension
The introduction of more and more drugs for the treatment
of hypertension poses problems for the clinician. In any
individual case a rational choice of drug should depend on
whether that particular patient needs to have his blood-
pressure lowered, the effectiveness of a drug in lowering it,
and the risks of its possible unwanted effects. In cases of
malignant hypertension with papilloedema the problem is
simple enough, since the outlook for untreated patients is so
bad' 2 that a powerful drug must be given and a high risk
of unwanted effects accepted. Guanethidine has almost
entirely superseded the ganglion-blocking drugs for this
purpose, but there is not yet encugh experience to say which,
if any, of guanethidine's relatives-bethanidine,' guanoxan,'
and guanoclor5-offers real advantages.
When hypertension is less severe, age and sex are as
important in prognosis as the level of blood-pressure or the
grade of retinopathy.6 For instance, elderly women tolerate
high pressures for many years. Nevertheless, lowering the
blood-pressure reduces mortality' I and possibly also the
chance of stroke.' " Reserpine and oral diuretics have been
much used, and in the last three years there have been
numerous reports of trials of methyldopa."-` The experi-
ence of Drs. P. Johnson, A. H. Kitchin, C. P. Lowther, and
R. W. D. Turner, of Edinburgh, reported in the B.M.J. this
week (page 133), is particularly important because they have
studied one of the largest groups of patients over a long
period of time.
Exactly how methyldopa acts is uncertain, but one of its
metabolites may displace noradrenaline from its site of
action.23 Methyldopa is rapidly absorbed and excreted,12
and thus must be given three or four times a day. It lowers
blood-pressure whether the patient is lying down or stnd-