Studying Stool Samples

The first and only time I’ve had to shit in a cup was at the CIWEC clinic in Kathmandu, Nepal. It was nearly ten years ago and, as a newbie traveler, I didn’t yet have experience with dysentery—the awfulness of things exploding, simultaneously, out of nearly every orifice.  When the friendly doctor asked me to “provide a stool sample,” something clicked in my mind. Of course. That’s how they diagnose these illnesses: they need to examine your turds.

These days I’m no longer an amateur when it comes to stomach bugs, and if I’m traveling to a high-risk place like Nepal or India, I treat my Ciprofloxacin pills with the same care as my passport.  Because the stuff works like magic, and I never, ever want to give another stool sample.

I’ve been so pre-occupied with the fear of shitting in a cup that I haven’t given much thought to the doctors on the other end—the ones who look at what’s inside the cup.  Until recently, that is. I came across a fascinating book, called “Travel Medicine: Tales Behind the Science,” featuring stories from heroic doctors who have dedicated their lives to studying stool samples.

Aside from learning new facts (“a shaken stool sample creates the sound of a marble rolling around”) and that diarrhea doctors have a sense of humor (one sent a crushed Baby Ruth bar mixed with water and red-streaked strips of paper towels to the lab for identification), there are true tales of medical discovery here. Like the story of the doctors at the CIWEC clinic, who, back in the 1980s, repeatedly observed an unidentified particle in patients’ stools that co-occurred with a sudden onset of cramps, diarrhea and nausea, followed by severe anorexia and fatigue. After six years of research, it was determined that they had found “the first new intestinal protozoal pathogen discovered in 70 years,” now known as Cyclospora.

If you’re interested in reading more about traveler’s diarrhea and obscure travel-related illnesses, check out the Journal of Travel Medicine, which publishes six issues a year.  Articles include individual case studies—such as “Leptospirosis in a French Traveler Returning From Mauritius,” “Transient Facial Swellings in a Patient With a Remote African Travel History,” and “Perniosis in a Long-Distance Cyclist Crossing Mongolia”—as well as reports of large-scale surveys, like “Incidence and Impact of Travelers’ Diarrhea Among Foreign Backpackers in Southeast Asia: A Result From Khao San Road, Bangkok.”

My favorite article? The cleverly titled “New England Souvenirs,” which, as you may imagine, does not involve a shot glass embossed with the Boston skyline.