Plague, rats, and ships The realisation of the infection routes of plague.

Three plague pandemics plus several epidemics have ravaged the world. The three pandemics were characterised by the role shipping played in spreading of the plague. The third pandemic, which began in southern China in the 1850s, was carried out of Hong Kong in 1894 to all continents by steamships. The oldest known documents mentioning quarantine as a precaution against epidemics dates back to 1127 in Venice. During the second pandemic, the Black Death, quarantine was systematised. During the third pandemic gassing of the ships was introduced by burning sulphur. Later hydrogen cyanide, carbon monoxide and other toxic gasses have been applied. In many harbours the use of rat shields were made compulsory in the beginning of the 20th century. The French bacteriologist Alexandre Emile Jean Yersin isolated in 1894 and identified Yersinia pestis as the contagious agent in Hong Kong despite obstructions from the British authorities who favoured Shibasaburo Kitasato from Japan. Four years later the French scientist Paul-Louis Simond established the rat flee, Xenopsylla cheopis, as the vector transferring the bacteria from rats to humans. This discovery was, however, not recognized until 1903 and another five years passed until clinical consequences were taken during the plague epidemic in India 1908. Each pandemic lasted several centuries due to reintroduction of Y pestis from local reservoirs in rodent populations in addition to reintroduction from the original Asiatic reservoirs.

[Canaries, germs, and poison gas. The physiologist J.S. Haldane's contributions to public health and hygiene]. / Kanariefugle, mikrober og giftgas. Fysiologen J.S. Haldanes indsats inden for samfundsmedicin og hygiejne.

The Scottish physiologist John Scott Haldane (1860-1936) spent most of his professional career in Oxford after graduating from the medical school in Edinburgh. He was deeply involved in applying basic science on problems in society but also making these problems guide his choice of projects in his experimental work. Thus, he has demonstrated that the increased contents of carbon dioxide in dwellings, schools, and factories was of less importance than the high contents of bacteria and fungal spores, and that even the foul air in the sewers was less harmful than that in crowded dwellings. He demonstrated that most miners did not die of lack of oxygen or trauma after colliery accidents but of carbon monoxide poisoning. The miners had relied on the ability of their candle or lamp to burn, but this would not be influenced by the presence of carbon monoxide. Thus, he introduced the canaries, which due to their small size and correspondingly relatively higher metabolism would faint about 20 minutes prior to humans. Haldane was called to investigate the ventilation and quality of the air in Cornish tin mines, since the miners suffered from fatigue or even fainted. The air and ventilation was sufficient, but the miners suffered from anaemia due to ankylostomiasis. After improving the hygienic conditions in the mines this became a minor problem although not completely eradicated. During World War I, Haldane became involved in protection of the allied soldiers when the German troops started using poison gas. In all cases he made rather drastic experiments on himself, his coworkers and even his son by exposing them to low oxygen, high carbon dioxide, carbon monoxide, or chlorine. He improved the gasmasks and introduced oxygen as a therapeutic agent. His big scientific mistake was that he insisted on the presence of an active oxygen secretion in the alveoli in order to explain the increased oxygen uptake during work and as part of acclimatisation to high altitude. workers and even his son by exposing them to low oxygen, high carbon dioxide, carbon monoxide, or chlorine. He improved the gasmasks and introduced oxygen as a therapeutic agents. His big scientific mistake was that he insisted on the presence of an active oxygen secretion in the alveoli in order to explain the increased oxygen uptake during work and as part of acclimatisation to high altitude.

The relationship between immediate relevant basic science knowledge and clinical knowledge: physiology knowledge and transthoracic echocardiography image interpretation.

Two major views on the relationship between basic science knowledge and clinical knowledge stand out; the Two-world view seeing basic science and clinical science as two separate knowledge bases and the encapsulated knowledge view stating that basic science knowledge plays an overt role being encapsulated in the clinical knowledge. However, resent research has implied that a more complex relationship between the two knowledge bases exists. In this study, we explore the relationship between immediate relevant basic science (physiology) and clinical knowledge within a specific domain of medicine (echocardiography). Twenty eight medical students in their 3rd year and 45 physicians (15 interns, 15 cardiology residents and 15 cardiology consultants) took a multiple-choice test of physiology knowledge. The physicians also viewed images of a transthoracic echocardiography (TTE) examination and completed a checklist of possible pathologies found. A total score for each participant was calculated for the physiology test, and for all physicians also for the TTE checklist. Consultants scored significantly higher on the physiology test than did medical students and interns. A significant correlation between physiology test scores and TTE checklist scores was found for the cardiology residents only. Basic science knowledge of immediate relevance for daily clinical work expands with increased work experience within a specific domain. Consultants showed no relationship between physiology knowledge and TTE interpretation indicating that experts do not use basic science knowledge in routine daily practice, but knowledge of immediate relevance remains ready for use.