X-rays à l'ancienne

As a medical student, you are often asked to "take a look at this X-ray". Sitting in front of the computer, mouse in hand, you quietly begin to scan the image in front of you for abnormalities. If the doctor has asked you to look at it, there must surely be something there to see. But you see nothing. Fortunately, you have a few tricks up your sleeve: a flick of the mouse-wheel and the image is magnified; a click-and-drag changes the contrast to further increase your chances of success. Still nothing. A few clicks and the patient's last two X-rays appear on-screen for you to compare. Expectant silence from the crowd behind you. Finally, there it is: a subtle fleck you had not so much ignored as simply not seen; suddenly the diagnosis becomes obvious.
Nowadays we're not often exposed to old-fashioned X-ray films, so it's easy to forget that this is a very privileged and modern way of looking at radiographs.

The scenario here is quite different. The X-ray comes out of a large brown envelope which is carried around by the junior doctors. Most of the rooms don't have a light-box, so you have to hold the film up to the light. This is harder than it sounds: too much light and you find yourself gazing through the image at the patients and doctors who are watching you. Not enough light and you simply can't make out anything. Try to ignore the fingerprints and the patient ID slip which has conveniently been stapled to the film. No zoom, no contrast setting, no integrated ruler; it's just you and the film, locked in a staring contest. The whirr of the ceiling fans is eventually interrupted when you accidentally loosen your grip on the film and it noisily flops down, lifeless.
When the decision to start TB treatment rests on your interpretation of the X-ray, you suddenly wish you had a dark room and a high-definition monitor to call upon.

The Glamour of Microbiology

Microbiology is one of those subjects which cause a double eyebrow-raise at dinner parties. "Oh! that must be interesting" is the usual reply, the emphasis revealing that there really isn't a follow-up question available for this area. No, microbiology is no Neurosurgery or Cardiology. No eighteen holes at the week-end for those who gaze down microscopes at Gram stains. But it can be fun nonetheless.
Nha Trang is a small city on the coast of South Central Vietnam. If you stroll down Tran Phu along the beach, you eventually come to the Institut Pasteur, a site of great importance in the history of infectious diseases. In 1891, a young Frenchman by the name of Alexandre Yersin set foot in Nha Trang and instantly fell in love with the place. Flanked to the east by the dark, turquoise waters of the South China Sea, and to the west by steep, green mountains, it isn't difficult to see the attraction. A promising scientist, Yersin had left Europe and the shadow of a certain Louis Pasteur in search of adventure. He joined the French Navy as a doctor and his first mission took him to Indochina.
Realising the excellent opportunity for microbiological research which the Far East offered, Yersin set up a modest laboratory in Nha Trang. Within a few months, an epidemic of bubonic plague hit Hong-Kong and Yersin decided to join the race to discover the organism responsible for the Black Death. The germ theory of disease was still in its infancy: what a coup it would be to unmask a disease which had claimed hundreds of millions of lives for over a thousand years! While several scientists looked for the bacteria in patients' blood, Yersin instinctively assumed that he would find it in the buboes, those swollen, necrotic lymph glands which give the disease its name. He struck gold: in 1893 he identified and described the microbe responsible, which has subsequently been named Yersinia pestis in his honour.
Back in Nha Trang, in the newly-founded Institut Pasteur, he set about creating a serum to cure the disease in the same way that Pasteur had done for rabies. He was successful again and his discoveries were able to immediately save thousands of lives. Not one to rest on his laurels, Yersin turned his attention to agriculture, developing strains of Rubber and Cinchona tree which would thrive in Vietnam, providing both rubber and quinine. He founded the Ecole de Médecine in Hanoi and also went on map-writing missions, discovering a route south to the Mekong delta and west to the mountain resort of Da Lat.
Yersin made Vietnam his home and never left. At his death in 1943, thousands of Vietnamese attended his funeral, and a Buddhist shrine and pagoda were erected by his tomb near Nha Trang. Still today, locals come to pay homage to a man who they consider gave his life and work to his adopted land.

Microbiology: no golfing week-ends, but potentially a prolific career in the sun and the eternal gratitude of an entire nation.