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Between 1861 and1900,1,352 overseas-trained doctors were registered to practise in Victoria, Australia. This paper discusses the causes of death in seventy-five who survived no more than three years after receiving their medical licence in the colony. The largest group died from tuberculosis, at an average age of thirty-one years. Probably all had left Europe with the infection, hoping that a cure would result from their 'therapeutic migration'. Whether that was likely to be a vain hope is discussed. The next largest group died by their own hand, and this paper argues that loneliness, alcoholism, and the stresses of adapting to an unfamiliar country may all have played apart. [ABSTRACT FROM AUTHOR]

Background and Aim: The rate of cardiac injury in upper gastrointestinal hemorrhage is unclear. The aims of this study were to determine prospectively the risk of cardiac troponin I release and associated adverse cardiac events in patients with acute upper gastrointestinal hemorrhage. Methods: From January to September 2003, we prospectively studied patients with documented hematemesis and melena referred to the gastroenterology unit in a tertiary teaching hospital in Melbourne, Australia. Serial assays for cardiac troponin I were performed at 0, 12 and 24 h. Serial creatine kinase levels and electrocardiographs were also performed. Clinical and biochemical data were collected. The primary endpoint was a troponin level >0.5 μg/L within 24 h of recruitment. Various clinical variables were then compared between the groups of patients with or without troponin rise. Results: A total of 156 patients were included in the study. The mean age was 67 years (range 19–96). There were 104 (67%) male patients. A troponin level of greater than 0.5 μg/L was found in 30/156 (19%); 126 (81%) patients had normal troponin levels. Age greater than 65 years, signs of hemodynamic instability at presentation, a recent history of cardiac disease, cardiovascular compromise following endoscopy, and re-bleeding were associated with troponin release. Conclusion: Upper gastrointestinal bleeding is associated with a risk of cardiac injury of up to 19%. Troponin assay could be used to screen for cardiac damage, especially in elderly patients who present with hemodynamic instability. [ABSTRACT FROM AUTHOR]