So thanks for that introduction. It means I can skip a couple of my slides and make sure I finish on time. So that's the bit that I can actually skip over quite nicely.

John forgot about the interesting locum work that I've been able to do, working in, in Mal, fabulous place, and then the island of Saint Kitts in the Caribbean, which is, conservation dream or conservation nightmare, depending on how you look at it. And that's the other project on the go at the moment is getting that little lady back on the road. So, yes, conservation medicine, .

After I'd left the practise in 2010, I have to say, you get to a bit of a, a loose, loose end. I, John didn't mention I came out of it because there was a change in family circumstances. My wife got heavily involved in the running of the hospital, and, she's now actually medical director.

So, my principal role is actually house husband. It can be done, guys. And I did need something to do, and I ended up having a chat with a bloke who farms up here.

This is the valley of Longsttle in the Lake District. It's a fairly typical glaciated U-shaped trough valley, depending on which era you come from geography teaching. And this line you can see where my cursor is going is the river Sprint.

It's a triple SI. We'll cover it a little bit later on as to why it's a triple SI. And I'll just draw your attention to this area of brown in amongst all the verdant green.

And that is a field of rushes that became very, very boggy because the farmer was not allowed to clear the land drains which exited into the sprint in order to be able to drain the land. And this was because it was triple SI. So I was acutely aware of this conflict, and I didn't know how to be able to speak to the people of natural England.

So this is where I got into conservation medicine. I wanted to know more about ecology. And the key thing is, because of family, I needed an online course.

And the only online that was not, I put too simplistic there, and some of them really were simple, was the Edinburgh Conservation Medicine. I was too late to start when the course began, so went for it the following year and I thought, I've got time, I can do 2 years in one. Well, that was a foolish idea, because last year, the ecology was just far too interesting for me.

And as John said, it took me absolutely full circle as to why I became a vet. 2-year course, the 1st 2 years are taught, and then you do your dissertation for the 3rd year, and I chose mine looking at liver fluke, and we'll cover it as one of the cases as we go through the presentation. And that last statement there, I wholeheartedly hold to.

There's a thing about learning later in life when the pressure is off you. It was absolutely superb. Very, very well run course.

So I'm going to run through the history of conservation medicine, where it comes through. We've had a couple of good talks on one health aspects, why vets are important for it, and running through some cases before finally getting down to what applications that can be there for normal practise. And a disclaimer, this is a very, overview, very brief overview of the topics involved in conservation medicine.

And if there are anybody listening that has more expertise in this than I do, then my apologies for, this light approach to it, but it's to get people an idea of what it's all about. Perhaps we ought to start with what conservation is. It's been around since about the mid 1800s.

Yes, historically, there are some parks across in Southeast Asia. The national parks are part of that movement, so things like Banff, the New Forest down in, the Southampton type area, is a sort of a park, originally just, just for deer, for the Normans to hunt. My own backyard, this is the Lake District, recently declared a UNESCO World Heritage site.

And I put this lake up. This is, a little article that popped up, some of you may have seen it, about the return of a Madagascan poacher by the Doral organisation. And one of the things they did was to create this particular area, they found this particular lake.

And rather than just concentrating on getting the species to survive, they actually preserved the area in which it would survive. And this chap Aldo Leopold had a huge Oh, this is a good little book I've just been given for Christmas, and I've ripped this, I've slightly it, but this quote really does sum up conservation. And losing the drama, well, of course, add to that all the planet Earth programmes that we've got where the drama is accompanied by music and there some superb photography.

In conservation, how ecosystems are going to be available for the future. And those resources, they're not our resources like oil or wood, that the resources that all the constituents of the ecosystem will need, nutrition, light, space. It's not preservation, it's not necessarily save the whale, because ecosystems will change and evolve with time, they have to.

That's part of their normal, normal evolution. And it does have to be most of the unfortunately are of our own making. And the whole idea ofine grew from the biology that was going on, because the people involved, when it came to infectious diseases, knew nothing about it.

Right, sorry about that, folks, one of the problems of, living up in the Lake District is, somewhat poor connections that we have. So to come back, the vets who were involved in, the darting of animals knew nothing about ecology and hence we got this nice little triad. I think none of these presentations are complete without a Venn diagram.

And it does sort of sum up reasonably nicely what conservation medicine entails. Ecosystem health would be something that might not be familiar to you all. It's again a relatively recent concept.

David Report, in a paper in '89, he was the one that started to discuss this as a, as a phrase and as a term. And it grew up with things that were happening in some of the Great Lakes. They were noticing mass mortalities of things like mayflies as a consequence of these algal blooms, and you can see the picture there, and that's not cloud, that's an algal bloom in in Lake Erie.

And they started to postulate, are there any early indicators of what might be going on. And this is a fairly I think, important aspect that a healthy ecosystem is one that has a high biodiversity. And within that paper there were sort of 3 essential tenants that a healthy one had to be distinguished from a sick one, things like vital signs.

It had to be able to recover from stress or change, and ideally it needed some risk factors that you could identify before a crisis happened. Now if you just think about those concepts, they're actually not dissimilar to what we do on a day to day basis as a vet. We will look at a sick animal, cow, dog, horse, cat, doesn't matter what.

Take the clinical signs, take the history, come to a conclusion. Those of us who are involved in herd or flock health work will occasionally look at things like conception data. So you'd be examining the farm records as well as perhaps taking bloods.

Thinking about parasites, you might want to consider which fields are high risk and which are low risks, and it all comes back to this concept that an organism is an ecosystem is an organism. That's involved with farm work are particularly aware of the ecosystem that's within the rumen, and there's sort of multitude of bacteria and protozo that that occur to help a healthy rumen. And the thing is that both have got homeostatic mechanisms, and we come back to those three factors identified earlier on, that there is this very nice crossover that vets really do understand and grasp.

That's a much nicer little Venn diagram to be starting with. This book is recommended if you do want to look into this area a little bit more, it's it's well written, it's, it's nice, nice one to read. And the similarities with One Health are there.

That's the One Health Triad. Interestingly, originally One Health didn't have environment, it was healthy livestock, healthy wildlife, but they managed to sort of realise the error of their ways and move on. That's a little graphic from the OIE.

This is a nice one. Of the, the sheer level of complexity and the multidisciplinary approach that both One Health and conservation medicine will require. You might have had something on that earlier on, but this, this idea of One Health again is a relatively recent one, but we now have it established, recognised by the World Health organisation.

But I felt this was a really, really important point. Martin Adler, previous record editor, managed to get together with BMJ, and this was a joint production. 13 years ago, I noticed as I was putting this slide together, I think we're overdue for another one, so I might nudge Adele on that one.

Now I tend to think that one health is very much it's a very anthropocentric view. It does look very much at things like food safety. I think the first talk was talking about this.

I put this little phrase in happiness from green. I've seen an awful lot of this is supposedly part of a one health doctrine, which, which I don't quite accept. And people just feeling good about being outdoors to me isn't one health because there's not that full interaction of all the organisms.

This is a very nice little phrase that comes from the Edinburgh website saying what conservation medicine is, application of one health principles to conserving biodiversity. I quite like these though. This is from a paper in 2001, how disease can affect biodiversity, but equally how species diversity can affect disease maintenance and transmission.

And biodiversity is something that gets talked about quite a lot, the loss of biodiversity, and I've put down these, the 36 standard aspects to biodiversity loss that are fairly well accepted with disease at the bottom. It's not necessarily a hierarchical one, but these are things that that contribute. So if we just add a little one to the bottom of that, is this something, this is something I'm becoming more and more interested in is disease risk assessment from an altered ecosystem, those risk factors that report identified, can we get in ahead of the game and say this is happening to this ecosystem, this might be the disease risk.

Because One of the things we have is this idea of the ecology of disease, and it gets slightly confusing because the ecologists tend to talk about in terms of micro and micro parasites, micro being viruses, fungi, bacteria that as vets we did bacteriology and microbiology, and the parasites are just the bigger things that we can actually see on the animals. It gets a little confusing at times. But as I said, ecologists talk about how things move between communities light, energy, nutrition, things like that.

Well, the parasites can move, the disease can move, and there's this concept of ecological epidemiology which is very helpful when studying actually any outbreak, not just one of conservation interest. You could apply this concept of agent, vector, and environment to something, say, like the bluetongue outbreak of 2006. And I think it's important for anybody who's got any interest in big conservation projects as a vet that that's really going to be vital for them, more so than the people doing exotics because they tend to, and I don't wish to be denigrating towards, they tend to be more individuals rather than the wild populations.

Livestock vets, you'll gain an awful lot for your parasite control or diseases with wildlife reservoirs. Even companion animal people, if we think about the importation of animals from Eastern Europe with the dogs and the diseases they're bringing back, it's important to think about it. And I mentioned parasites a lot, going back to your parasite lectures at college, you always need to break the cycle if you're going to control them.

And these are a summing up of the sort of actions you can take in order to be able to control either micro or macro parasites. But to do so, you've got to identify the hosts, and the list is rather long and unfortunately, isn't there always academic disagreement, there can be a real problem with what people mean by what particular reference. So is a reservoir and the same as a competent animal, is a spillover host the same as an incompetent host, and it can get a little bit tricky out there.

I'm sure it will get sorted out eventually. So a couple of examples in broad terms, if you wanted to control fleas in dogs or cats, well, you don't want to take any action against the host. You get into a bit of trouble there, but you do act against the parasite.

You do act against the free living stages with the household sprays, and yes, you would perhaps try and manipulate the environment a little bit by burning or washing the bedding. You can't do a lot about host parasite interaction. If you look at rabies control the landscape level, and I was interested to hear the previous presentation.

Yes, some people have tried culling the infected animals. The action against the parasite, yes, the vaccine very, very successful. These two areas we can't do anything about, but this one, perhaps we could.

I've put waste there because if rabies did manage to get into the UK and it does seem increasingly less likely, our fox population, particularly our urban fox population, are a real issue. So one of the things to do would be to simply reduce the amount of waste food that's out in the cities. And I put this down at the bottom, these ethical aspects, anything that involves culling involves some form of ethical aspect, as workers will go on and see anything that acts against the environment.

For two perhaps nice little examples to choose. The Ethiopian wolf, fairly endangered animal, lives up in the Ethiopian highlands, and it's a highly threatened population. A vaccination has been tried and done, and obviously baiting is one way of doing it, but the hosts have to be considered here, and the essential hosts are the domestic dogs.

And as you've heard earlier on, vaccinating domestic dog population is vital for human health, but it's also crucial for some of the big conservation projects we've had, and certainly vaccinating villages dogs in and around the area where the wolf exists has been highly successful. A slightly different approach going closer to home, the red squirrel problem that they have with squirrel poxx, which came in through the introduced grey. And where you have a situation like this, and you've got a reservoir in one animal, the red is a spillover host, but has no immunity to it, so they all just drop dead.

Culling in this instance has worked extremely well. Anglesey useful by being an island, but they've completely removed all of the grey squirrels. The red population is recovering very, very nicely, and the same is actually happening in areas around the Lake District where villages have coal policies for the grey squirrels.

The reds are bouncing back with sometimes 2 or 3 litters a year. I'm going to look in more detail now at 4 very particular problems, each with a sort of slightly different aspect to it that is part of the conservation medicine, thinking. Lyme disease, TB, I almost can't avoid that one, I'm afraid, the Sega antelope, and then say fascilosis, which was the subject for my dissertation.

So the thing about Lyme first, this was first diagnosed, yes, mid 70s or so, originally thought to be some sort of childhood rheumatoid arthritis before finally Mr. Bergdorfer isolated the bacteria concerned. And as you probably know, arthritis, meningitis are the principal problems that we get.

There is a huge amount of chatter on the effects of chronic Lyme, most of which is actually sort of, highly questionable. Not least because testing is very, very imprecise. The UK, we have about 1000 cases annually.

I think that's been increasing. I think the last Public Health England data was about 1600, so it's been on a steady increase since about 2000. As far as canine cases, I actually couldn't find any hard data in preparation for this.

I did ask a colleague who's an orthopod, and he said yes, we test, but we very, very rarely find it. But this is not a new disease. This is Ursie, who I have to say doesn't look terribly well, and Ertzi's body was found at that point where the red dot is on the Austrian-Italy border.

He was originally thought to be a climber that had been lost in an avalanche until they realised he wasn't exactly wearing Gore-Tex, and Uzi is actually from the copper age. He's over 5000 years old. And the curious thing is that they did some PCR testing on the blood, and they found Evidence of Borrelia there, it wasn't 100%, it was about 60, 65%, very high probability that he'd been exposed to Borrilia over 5000 years ago, so it's not a new disease.

Go back to this slide that I put up earlier on, how would you control the parasite, identifying hosts and then taking action against them or the environment or reducing their interactions. How this fits into Lime, there are a stack of hosts. But you are really concerned about what the reservoir hosts are.

In other words, the ones within which the disease circulates and is maintained. And that comes down largely to small rodents. If you're in the States, you've got the white-footed mouse, or if you're in the UK you've got the slightly cuter looking yellow neck mouse.

Most of the others tend to be spillover hosts, so they are capable of being effective, but they're not really that important in the maintenance of the cycle. Lyme complicated, of course, because we have a vector involved. The scapularis there for the United States and the more familiar riinous one for Europe and England, Scotland particularly as well.

Excuse me. And the bacteria is not thought to be trans transovarial rather, it will go through the stages. It will go through nymph and through into adult, but it won't actually be transmitted through the egg.

Now in preparation for this, I did come across a paper suggesting that some evidence of transvirial transmission had been found, but it was felt to be relatively unimportant in the general scheme of things. So the larvae, the much smaller ones will become infected by feeding on the mice, the reservoir. The nymph, also capable of feeding on those same mice and becoming infected, but that can be affected as part of its transtageal changes, it will pass the infection on to other rodents.

The adults tend to feed off the larger hosts, things like deer or even ourselves. And they become important because deer in particular in the UK are tick amplification host hosts, and one person who was studying this that I know of refers to deer as a tick bus because they just can move such huge distances on the deer, and the deer themselves are not important in Lyme itself, but because they potentiate, they amplify the ticks, they are actually important in the total epidemiology. And if you wonder why there's been such a huge increase in the eastern US, you need to go into food webs and the ecology and consider what happened.

That from the time that western humans started to colonise the states, they were clearing the woods. Anybody who read Little House in the Big Woods, Little House on the Prairie will be familiar with this concept. They pretty well exterminated all the wolves.

And then people moved away, they moved west. The forest regrew or were planted, a lot more deer arrived, that's whitetail deer. Big increase in ticks because it was getting slightly warmer and a huge increase in lime.

Except it's a lot more subtle than that. When the wolves were killed, Wolves normally will prey on coyotes because they are pretty similar competitive or similar resources. So there were more coyotes.

The coyotes unfortunately also prey on foxes for the same sort of reasons. The fox's main prey? They're kind of a specialist mouse feeder.

So you've had the lime reservoir taking, having its selection pressure removed on it, the prey pressure removed from it, just at the time that there were more ticks, also just for the time that more people wanted to live in these nice semi-rural areas with lots of trees and a nice environment, a bit of a perfect storm if you like. And into this mix comes this discussion about the value of biodiversity, and this paper from 2001 looked at the distribution of Lyme cases and comparing it to the species richness in the forests and found that the fewer species you have, the more Lyme cases you have. And this is the approximal hypothesis that if the white-footed mouse are the owner or the main species in these little clumps of islands, these island woods, they are the only I put prey is a very loose term.

They're the only source for the ticks, and they're a competent host. If there were more species, particularly the incompetent hosts, the spillover hosts, then there's going to be less chance of each individual tick becoming infected. Now, as you might imagine, any academic hypothesis will get contested.

And while this certainly applies to one competent host, if you've got more than that, it can be a problem, and the, the people who contested this, this ideaoo and Lafferty, certainly found that in these rural, semi-rural areas. Where there were clumps of woodland, yes, you were getting higher lime, but actually if you went to the bigger woods and expanded the number of species, so there were more competent hosts, then the difference wasn't quite so clear cut. It's complicated.

We are dealing with . A very complex interaction within the natural world and we all know how complicated it is just dealing with the interactions of one homeostatic single organism, let alone a multitude within an environment. But I would suggest that in general terms, within ecology and disease at the landscape level, the dilution idea is, is more accepted than rejected.

We may consider what's about Lyme in the UK. We've actually got several other competent hosts. The grey squirrels and voles are all all part of it, and I've put this little thing here that this concept of co-feeding, where 3 or 4 ticks will actually feed within almost a tick distance of each other, and they're capable of infecting each other simply from that localised infection.

So you don't need a full blown bacteremia for transmission. We've got a big deer population, a lot of ticks, a lot of sheep, and we have a lot of people wanting to be outdoors, so it's perhaps not surprising we're seeing a, a slight increase in Lyme cases. Now I've just thrown this one in.

This is purely my own, my own thinking, but I have fell to wondering that the ideas of introducing the lynx back into the UK has some merits, but one problem it might have is its impact on something like lime, because the lynx eat the foxes, again, they regard them as an intra-gild competitor for their resources. Now some of the young lea lynx will still eat the mice, but the main prey of lynx is deer, so I'm just curious as to what might actually happen there. And on a slightly side note rather than Lyme, this is the one I'd be more concerned about, which is tick-borne encephalitis, very common in Scandinavia and throughout the sort of the eastern area of Europe.

And unfortunately it's very similar to Laoingill in the UK, which is a disease of sheep and of grouse. It shares the same vector which is the tick. And we've got the right sort of temperature for it to survive, and it's really nasty, it's, an acute and fatal meningitis, although thankfully there is a vaccine for it.

So one maybe to be looking out for some survey work is actually going on as we speak. Lyme is ridiculously complicated. But it really is only a problem for humans.

It's not an animal wide issue. It's a good one for, excuse me, conservation medicine, because there are so many aspects to consider, and I have put this at the bottom. I think a lot of what, I've learned about and what I'm doing is actually asking questions rather than necessarily having all of the perfect answers.

So if we move on from Lime and consider TB. Reasonable question to ask at the beginning, is it more or less complex than Lyme? I think if you took the politics out, it would be less complex.

But we have a similar thing of a multi-host disease, it's quite a slow onset, typical of all the mycobacterium, and of course we've got zoonotic problems. And this slide is a badger with TB. That's from the inside of a cow, you can see the lesions all the way up here.

These are lymph nodes from a wild boar, and then finally a picture of a human with sort of cutaneous TB. The real problem in the Middle Ages, the scroula King's evil, it was sometimes called, really quite an unpleasant disease if you think about it. Huge number of species involved with the mycobacterium, but M.

Bovis is the one of main interest, mainly because it's got the widest host range of, of any of the mycobacterium. Big problem in the UK in the late 18, early 1900s, slums, poor nutrition, . City dairies were another one.

There were farms actually within cities, so the transmission was really, really easy. And it was brought under control simply by TB testing, telling the positive ones, better food, pasteurising the milk and meat inspection to make sure that, All of the potential infection had been removed, and a very successful policy, it nearly got rid of it all until early 70s, where there was still a small reservoir in southwest England and eventually it was isolated from badgers and as they say, that's when the trouble began. It's interesting to speculate where M.

Bovis actually came from, certainly sort of its phylogenic origin. The general impression would be that people get the infection from, from the animals. But actually it might come the other way.

There's some phylogenic evidence saying that M. Bovis originally came through from the mycobacterial infections of the of early humans or even slightly earlier than that. But again, it's it's a bit nebulous this one.

I have seen papers suggesting that it actually both arove from an early ancestor. But it's interesting just to speculate on that one. The World Health organisation regards TB as a very important disease, an existing stroke re-emerging one.

It's a disease of conservation interest. Things like lions in the Kruger have suffered because of the infection within the buffalo, and most of our problems with it relate to the wildlife livestock interface with the reservoirs we've got. So New Zealand has the possum.

USA, the deer, Spain, wild boar, possibly some red deer, and then of course the UK with the badger. Back to the slide of control of parasitic disease. The hosts, essentially badger and cattle, all the rest are spillover hosts, that still holds true all the work that's been done, those two are the main sources of M.

Bovis within the UK. You could reduce the interactions, preventing movements, access to maize, I've put possibly actions against the environment for slurry spreading. And certainly actions against the host are being done because you're culling the infected animals.

The action against the parasite itself almost forget it, there are no treatments for it. Human treatments of human TB is notoriously difficult to do, very, very long duration of treatment, and unfortunately the BCG vaccine, it's it's quite lauded, but one of the problems with BCG vaccine. It's there to reduce the pathology.

It was brought in to stop people getting spinal or meningeal TB not actually preventing the onward spread of infection, so it isn't anything like as useful as, say, vaccinating for rabies. But it's a problem, keeping apart a grazing animal and a specialist worm predator. Certainly a lot of ecologists regard badgers as specialist worm predators.

I know they've got a very good omnivorous diet, but oh boy, do they eat worms. And we've had this massive increase in the population in the last 20 years of essentially a protected species protected because of badger baiting, which means that removing the infected animals is actually quite difficult. It's interesting to look at the badger ecology because they're rather curious.

They have group living and yet they're not that social animal. There's no cooperation between badgers for things like gaining food or reproduction or rearing of cubs, which are the usual reasons that animals will actually cooperate and live together in a social structure. There's a single reproducing female in the set.

And young females will either move away, or either or succeed as one that dies. Mates, males rather tend to just go with the sexes. And both the male and the reproducing female scent marked the boundaries to declare the territories, which might provide some interesting thoughts on control.

So what controls could you do of that particular reservoir, certainly, obviously culling, quite controversial. Some thoughts about identifying individual sets because they're the epidemiological unit, although modelling has shown that may not work. It has to be said that complete successful culls have been done.

The Thornbury studies is worth looking at. Randomised badger control trial gave somewhat equivocal results for a couple of reasons, but these are some interesting thoughts that are being put forward. The contraceptive vaccines that work either against the zona elucida or atrophin releasing hormone, very interesting ways of controlling populations and have been used to control wild horse populations quite successfully.

And then I've logged this in at the bottom, . If the badgers are prevented by moving because of the scent of reproducing females, well, if we could replicate that, could we somehow stop these animals from moving around too much taking disease with them? I'm speculating that.

I found that's one of the things that I'm studying this course because it's got such a a multidisciplinary idea, it tends to spark ideas in in sometimes crazy ways. I have no idea whether that would work or not. It was just sort of random thoughts.

The cattle controls that we have, we do cull them 30,000 a year. The movements, apologies to any farm vets who are listening to this, but I still think we've got a problem with our movements, and we should have grabbed hold of that issue some some considerable time ago. But I think this is a real problem that TB is still regarded as a government imposition on farmers, not as an infectious disease.

The testing is limited, but it does have absolute value. You've got to understand the limits of sensitivity specificity. A positive skin case, just as if those that aren't involved in this, is TB, a negative skin case, that's the less certain one we can get some false negatives, which certainly when you move animals around is an issue for control.

And a lot of social science is involved because you've got two groups of people who don't like each other's control methods. In fact, not just don't like, won't accept them. There's very few people with a farming interest in parliament, so those with more of an animal welfare and lobbying.

Effort have, I think, probably greater greater hearing. And then there's a lot of modelling going on as opposed to using hard data and social science absolutely vital to understand social science and human behaviour if you're going to become involved in conservation conservation medicine. It did form chunk of the course, and it's vital to understand how people think and get them to perhaps be accepting of things that might threaten themselves.

So we move away from human things and consider. A pure conservation disease, and this is the mass mortality of the Saga antelope, this rather curious splendid animal that's there in the picture. Those of you with young children may well remember the ice age cartoons, and there were certainly these sorts of animals doing the rounds in there.

They are very much a remnants of the last ice age, and sadly they are critically endangered and were critically endangered even before these mass mortalities crept in. And there was a big one in 2015. And 200,000 animals dying in 9 weeks.

In one area, 80,000 died in nine days. It, it still takes some thinking about that, and that's from somebody who went through the, the horrors of 20001 ft and mouth. The Sega live in these, these steps over here, the Kazakhstan around the Aral Sea and a small population across in Mongolia.

And they're threatened for all the usual reasons that animals unfortunately are threatened. They're poached for meat, particularly in some of those communities where food is hard to come by, and the horns are occasionally used for traditional medicines. There are issues of land use as there are with anything else and then diseases.

PPR is on the rise. It's a particular concern at the moment of anybody with a small ruminants, sheep, goats, but it is a population threat to the Sega. And these mass mortalities have been going on for quite a while.

Certainly there were several in the 1980s. The saga is quite remarkable in how it will, it will carve down in these large herds herds with calves being born within a matter of days of each other, probably more so than things like wildebeest. But 2015 did see this really, really big die-off, and a huge team of people was put together.

Richard Kock at the RVC, was principal in leading this team, and they did everything and found they had this hemorrhagic septicaemia from which Maltocia was isolated. To refresh you, Maltosita is a fairly ubiquitous pasturella, one that we see in an awful lot of species, so it will cause pneumonia in cattle. It'll be the main constituent if you've been bitten by a cat and got infection from it, that's gonna be pasturella.

Atrophic rhinitis in pigs. It does cause pneumonia in sheep, but peculiarly not in the UK. Another disease of conservation interest is maltosita in the big horn sheep in the states.

That's been a real problem they've been trying to get on top of for a while. And this is a curious thing, it's a commensal. And the question for the group was what triggered that commensal to suddenly become pathogenic?

What triggered these deaths? Now, fortunately there were some researchers within Kazakhstan looking at these animals already, so they were able to very rapidly get this team assembled. And this is a sort of typical picture you see.

These animals are separated by something like 30 to 40 metres when you've done the The GIS, the geographical Information Systems and you plot where these animals are. They literally are falling where they were walking, and very quickly people realised that this was not going to be horizontal transmission of a highly infectious disease. This had to be something that was happening to 80,000 animals all at once, and the one that they isolated was relative humidity.

That where the mass stars were happening, the relative humidity was massive compared to areas where there was no mass mortality. And this is the other curious thing that was happening is that there was nothing in the pre-Soviet literature about these mass mortality events and nothing in the folk records. The vote record can be quite interesting if you recall the programme it was on a few years ago on the Barrier Reef.

There's some comment there that actually the native population in Australia have as part of their folk record, their songs, the formation of the Barrier Reef, which occurred about 10,000 years ago. So this is the speculation. Is this an aspect of modern climate change?

It's just too warm for these animals. It still doesn't explain the exact aetiology of why the change went from being commensal to being highly virulent and spreading throughout the body. It has to be something related to .

The back of the throat, pasturea breathing madly because of a change in circumstances, possibly through breathing too heavily, and these things are all speculation, nobody quite knows yet. So we move on to how you can look at disease that will be part of normal practise. And this is me looking at liver fluke as part of my dissertation.

It is a good conservation medicine project. World Health organisation concerned about it, particularly in places like South America where it's on the rise, and there are very few control options available. So there's the little beastie.

This is an adult fluke that would normally live in the bile duct just up here, which is slightly thick and you can see as a result, maybe a little bit of a reactive lymph node there. And this isn't the liver of a red deer, but the liver itself is in pretty good health. Red deer don't seem to get quite such a bad impact, unlike the distant cousins, the roe deer.

And this really shows the damage that migrating flute can do to a liver, the large areas of necrosis and damage, and there's still enough liver tissue there for the animal to survive, because this is an animal that was cold and it was perfectly healthy up to the minute that it was cold. And it's been on the rise. OK, this data is now 10 years old, but this line is still going up.

Last year was a relatively good year because it was so warm. The previous years have been fairly bad. And they're the 4 main reasons why we're seeing such a change, that there's resistance to the drugs that we're using, in particular trilobendazole, which is the only product which will kill all of the stages within an animal.

Certainly climate change aspects, big problems with land use change, and perhaps rather unkindly put in the green blob, that somewhat awful phrase that Owen Patterson used a while ago, but it does sum up sometimes how environmental. Conservation issues can often override all of the considerations. We start with climate change.

This is data from the last 100 years, and the two important figures are the ones on the left and the ones on the right, the change from 1910 to 2015. That temperature there, 9.5 degrees, is the lower critical temperature for fluke.

It's the temperature at which the free living stages are capable of surviving. It's a temperature which the snail starts to move around and become active. So we now have an average temperature throughout the year where both the parasite and its intermediate host can be active, and that's a real problem.

Then add in the wet weather. This is the view from my bedroom window in the aftermath of Storm Desmond. This should normally be all fields as far as you can see, but as you can see, there's a whole load of flooding there.

And whatever is happening or whatever you think the causes of climate changes are. This is what's the net result, that parasites are adapting to it a lot quicker than we can, in fact a lot quicker than we can think. And this paper came out a few years ago, there could be areas such as mid Wales that cannot graze livestock because of the threat of liver fluke.

Land use changes. These pictures were as part of a leaflet in the wake of Storm Desmond as to ways by which farmers could use their land to act as a sponge and prevent downstream flooding. This area in particular is a wonderful area for snails.

You've got this small temporary water body with all this mud surrounding it. So these are increasing the host range, the reservoir sites for the intermediate host. And then we talk again about how we go back to this picture of long sleddle, this problem of triple SI's overriding other views.

It's triple SI, the river sprint, because of the white clawed crayfish. It's the UK species which is threatened by the signal crayfish which has been introduced from the states and unfortunately we brought with it a crayfish plague. So we have these triple SIs and as I said earlier on, there was this difficulty that the farmers couldn't clear the land drains.

Now furnace to Natural England, the farmer's idea of clearing the land drain was to stick a JCB in the river and dig the river bed out. It furnished the farmers, when it used to snow properly and you get the snow melt, the water would come down through the river sprint with more power than JCB ever could. But there's this thing of competing interests, and currently in that area, the ecological interest of the tripleSI is winning over the disease interest of the liver fluke.

Those of you who did well to forget everything you knew about farm animal parasitology as soon as you left university, a brief review, the egg will hatch into the mireidia, which is one of the motile stages that immediately penetrates into a snail, Galbatrocatula and small mud snail, and it clones itself within that, undergoes a couple of divisions and can clone itself such that one miroidia can release something like 1500 copies of itself. Another motile stage, a icaria, moves on to the pasture where it insists and it can survive for anything up to a year. That's eaten by the sheep or the goat or the horse or the human or the pig.

You keep naming them, and it will exist in the stomach. Burrow through the stomach wall into the liver, and then spend the next 10 weeks migrating through the liver, eating it, damaging it before finally emerging in the bile ducts and staying there pretty much for as long as the animal lives. There is no immunity to liver flu.

They're very cunning, really. That's the wrong word to use. It's pure pure evolution, but they've got an evolutionary tactic which does look like extreme cunning they can hide from the immune system.

And this little infographic here gives you an idea of what we normally would experience that after the, after spring gets warmer, you'd have an increase in the snail population which in itself would lead to an increase in infection on the pasture and then a little bit later on an infection rise in the animals. This year's been very interesting because it's been so dry, the snail population will be somewhere down here. So the pasture infectivity is somewhere down here and inevitably we're not seeing much fluke at the moment.

I suspect as winter goes on, we may well see more problems because certainly around us it went quite warm and moist in around September. But this is what you have to consider, of when do you need to treat. Given that you can only treat in the in the mammal, you'd be wanting to treat roughly around about this sort of time here, trying to hit the, the peak of infection.

And one of the problems we have is the biotic potential of both the fluke and the snail. These, these figures are no exaggeration. It's remarkable just how much one adult fluke can put out and to give this potential millions of infected stages.

Galba equally many, many thousands of descendants given perfect conditions. So we need to do a little bit of a rethink, I think, on this one. Excuse me, a quick sip of water.

I need to have a different way of thinking. Because we've always regarded fluke as a disease of the mammals, but actually, Galba undergoes parasitological change, undergoes pathological change. They get bigger and they get castrated because the stage that gets into the snail, the reedia, actually actively eaten away through the ovot testis of the snail and castrate it, they become sterile.

So you do have to think about fluke if we're going to control it, very much as an environmental disease. Back to this stage, this slide of how to control parasites where you would take action. You don't really want to act against the definitive host here, these are the animals of interest of production animals.

And I listed before, but you can see just how many different hosts there would be, and of course how many rabbits and hers and deer there are in the UK. Our drugs unfortunately just don't work very well, and there are no vaccines. The vaccines are a long, long way off because the immunology is so complicated, you can't do that.

You could take action against a snail to break this cycle, and that used to be done. Copper sulphate used to get applied to the land, but it's banned because it's fairly indiscriminate in what it will kill off. Ducks are an interesting one to look at, and Jenny, who's a vet up in Northumberland, put a letter in the vet record a short while ago.

Showing that where a farmer had to keep the ducks in because of avian influenza, they start to see an increase in fluke in the livers of the sheep. The same problem happened this year, 2018, not because of avian influenza, but because unfortunately a fox came calling one night and killed all the ducks. There's certainly a question that they should be used more for that.

You can do direct biological control of the snails, both with parasitic flies or carnivorous snails, but if you just think of the the cane toad in Australia, you've got to be so careful when thinking about a biological control. But even cutting the population of the snails in half is not going to make that much of a difference when only about 10% of them are infected. If you do the math, you can see why that just wouldn't work.

Some people have looked at treating parasites within the snails. Prasaquanel actually does work against the snail stages, but, I have fun gettingrontal into a cat, let alone to an animal that is actually probably smaller than the tablet. Farmers do do the thing of reducing host and parasite interactions, draining land, fencing bogs, but as we've alluded to earlier on, the drains can get blocked and snails, in good years, the population of snails can expand beyond the fences.

They're not absolute means. A more contentious one would be to act against the environment, and this certainly was tried in areas of Africa for sleeping sickness because the sexy flies tend to rest either in the day or the night depending on which species they are. So they decided to burn the vegetation.

It worked, but it had a lot of collateral damage. You've got to balance it up with other factors, and this is all the problems. It can be counterproductive.

The tetsis tend to go for these umbrella shaped trees, which are just part of the landscape because they've evolved to cope with things like elephant browsing the lower branches and to cope with forest fires themselves. And there is this question of is it ethical to act and damage the environment. You need to think laterally.

You need to think in very, very strange ways in order to control this particular problem. This is the essential elements of it that the mammal and the snail have got to meet. Essentially, the faeces have got to be dropped in the snail habitat because the snails don't move very far.

And equally, the sakeri that emerged from the snail must be on some form of vegetation attracted to the sheep or the cow or whatever it is that's going to graze it. So we know that snails have got these reservoir sites. Could we look at what those factors are that lead to those sites and therefore target them, and this is the basis of my research that I did.

And essentially, snails like recently disturbed mud. That's because they eat the algae, which is the first thing to colonise you, you'll know full well wet ground, smear footprint where you've walked within a couple of days in summer it's gone green. And they like these areas of low biodiversity.

Back here we are again with low biodiversity and a disease issue because there are no competitors, no predators. So I looked at why, what the common factors were. We've mentioned this 9 degrees C.

Moisture was the other factor. Everything else, salinity, hardness, alkalinity, doesn't matter. These organisms have evolved to cope with a very rapidly changing environment, so they've got very high tolerances for big ranges of pH.

You can't change the temperature. But we can wonder what drives soil moisture. And that's a reflection of soil structure, the underlying geology, and these are three terms that I think are all at this stage we need to understand soil structure itself being an entire degree course.

So field capacity is a soil that essentially is drained of most of the moisture within it. All the pores are drained and they're full of air, and a saturated soil is the exact opposite. All the pores are full of water.

You then have a waterlogged soil where time has come in and it's waterlogged for so long that you get this strange change, and instead of the soil being a nice brown from the oxidisation of iron compounds, it goes grey and blue, and that substance, that glay actually sticks together and actually makes the drainage worse and enhances the water logging. And glaze soils are very common in the western part of the UK, so that's the typical area we start to see fluke. Trees and vegetation have an impact on soil moisture.

Three-ways trees will do it, they'll stop water falling on the ground, they'll increase the soil permeability, and they'll move water actively out of the soil. And you'll all know this, woodland is essentially drier than pasture. The soil is more stable.

Such things like that. Quick example here, this beech tree on the left, the edge of the canopy dropping a straight line down to where the approximate edge of the roots are, you can see there's decent grass underneath that, but beyond it are the rushes associated with damp ground. There's more grass growing around this hawthorn tree.

But if you have a look over here to the brown of the rushes, what's going on, here's some rushes all the way around the tree, but actually this is a dead tree. Look at the crack going up it. So there's no leaves, there's minimised interception.

There's no transpiration, and the drainage will be seriously affected because the normal mycorrhiza, the fungal root symbiotic, just isn't happening around there. So what could you do? If you've got stable soil, there's less mud.

Less mud is a less food for those snails, therefore, there's going to be less infection on the pasture. If there was more vegetation, again you'd be restricting the algae that are growing there. And if you kept the soil at or below field capacity, then the free living stages of the parasites, so that one's coming out of the egg into the snail and from the snail to the pasture, they simply can't move, so the site will be blocked.

Now I'm talking about acting, doing something to the environment, and I've thrown this out several times, is it ethical? And this is where I get a little controversial with some of my farming colleagues, because I might just argue that pasture is actually a damaged ecosystem. I have very little truck with George Monbiot's ideas, but I would suggest that perhaps improving pasture has actually increased the snail habitat.

For these particular reasons, we have bigger animals, we have bigger tractors, so there's more disturbed mud on the ground and reduced drainage. That mud supports the algae and the growth of that. I mentioned eutrophication within the Great Lakes earlier on.

Well, you can also get that at a much smaller level on a field because of too much fertiliser being applied to it. Plus we line the fields. To improve the uptake of the fertiliser by the grass.

In other words, we have created an ideal snail habitat. And there's a, a good example of where a tractor has gone over some land and left behind it, a lot of compaction, a lot of bare mud, ideal for the snails, a lot of little bits of standing still water ideal for the free living stages of fluke. And then just a sort of a a wider view on that, there's the muddy area here.

Compare that to this area here where the tractors just haven't been and how full that is of molehills because of the number of worms that are there. This is just too compacted for the worms. How do we do it?

We know what the sites are. We'd plant them up with trees, flowers, shrubs, which ones? You have to go native, things like bog myrtle could be an interesting one, but we need to watch out for this baby.

Bog Asphodel if there's some farm vets on there, we know that's quite toxic, particularly to sheep. I'm all about encouraging the biodiversity. That might be a downside because if we have more woods, we're going to have more head fly, and that could be a bit of a problem.

So moving away from that, one of the things I was asked to talk about. With bigger, wider applications of things like conservation medicine, the idea of ethical eating. And that's obviously a lot in the news at the moment, not just because it's vegannuary, I think that's how they pronounce it, but the recent production that's in the The Lancet, not had a chance to read that one yet.

A lot going on about how much of what we eat affects the climate, and I would suggest you need to look beyond the headlines and really don't trust the data. A lot of these papers are not ethically reviewed. And it isn't just the the carbon that people get fixated about.

We need to think about water. We need to think about the pollution that's involved, the runoffs, the eutrophication, or the land use. Individual ethics about simply either using animals or killing animals, and BVA is very much behind the idea of good welfare during the animal's life and good welfare at slaughter.

And then this one is a huge one, but gets less discussion, the amount of waste that goes on, both in terms of the production cycle and of course the humans from eating. I think the figure's something like 1/3 of what we buy to eat we actually throw away. And the studies are contradictory.

One particular PhD I've been looking at recently, comparing the total impact in terms of greenhouse gases of almond milk versus real milk, and they're pretty much the same. Certainly cows will produce more methane in the original production, but by the time you've shipped these things around and take them to cos the amount of water they require, the impact, total impact is pretty much the same. And then this curious one, because forests actively release methane as part of the breakdown of the of the litter on the floor.

And this is the trouble. Go back to the social science. The data's being used selectively depending on who's stating it.

And one thing I'm acutely aware of is that everything that's being said is very much that view from a comfortable developed nations who knows where their food is coming from. What are the certainties? Too much is consumed, too much is wasted, and my personal view on it is to eat less, eat better, and this one, learn to cook.

If you actually look at some of the data that's been produced on all of this and verifiable peer review stuff, anything that's processed has the biggest impact of all. It doesn't matter whether it's a pure vegan product like Greg's vegan roll or a sausage roll because they're so highly processed, they're the ones that have the highest impact. And please do bear in mind this whatever your views are that animal products can often lift some societies out of poverty.

Looking after small ruminants is often the key to female emancipation, which is one of the best things for reducing overall population growth. I mentioned disease risk assessments earlier on of how you could look at ecosystems, consider what diseases might emerge from them. And this is quite a nice one, the Nifah virus, which was an issue a few years ago.

Essentially in Southeast Asia they were cutting down the forests for pig farmers to provide protein for the population. The pigs needed protecting from the sun, so they planted some mangoes. The fruit bats, which is the reservoir of Nipah virus, eat the mangoes.

They fly in from the forest because we've chopped down all the natural trees and eat the mangoes that are over on top of the pigs. Essentially, the bats pee on the pigs and so pass the Nipah virus onto the pigs and then on to human beings. The other means of getting it is if you are travelling in Southeast Asia, do be aware of eating the date palm, drinks that they brew out there, whether it's come from a protected one or whether it's a sap that fruit bats can pee into.

If you saw Planet Earth 2, I watched this episode again quite recently, The Cities one, absolutely superb. In Mumbai, you have an awful lot of pigs. There was that remarkable footage of the leopards taking off the young piglets.

In Jodhpur, the langa monkeys, which are deliberately fed and have a huge population in the area. And Most of these cities have street chickens. And this guy balancing these chickens, I think these are all alive at the moment, on the back of the motorbike.

They have no concept of biosecurity. And if you put together Humans, primates, pigs, and chickens. If you just think of the potential diseases that can circulate through from those and back into humans again, avian influenza being the, the obvious one, these are high risk areas, I think, and I don't think enough is being done to address that.

In summary, conservation medicine, a bit like the Beatles, it's, it's greater than the sum of its individual parts. I regard it very much this studying of how diseases flow through the ecosystems and how those can be affecting either conservation projects, livestock farming, or human health itself. It's a big picture thing.

I think that's one of the things I like about it. It involves an awful lot of ecology, an awful lot of understanding about evolution. I'll finish on this this excellent quote, and I would thoroughly agree with it.

There can be almost no pleasure deeper than trying to understand the natural world. Doing the conservation medicine course makes me think I can actually alter that to say, and coming to understand it, except when you realise that that's from David Attenborry, you never really want to argue with anything that he says. Thank you.

Thank you very much indeed, Ian. A really fascinating insight into conservation medicine and what it's all about, and probably we're all going to be rushing off to register for the course at Edinburgh. But I think you've really given us something to think about how it can be relevant to general practise, the whole concept.

We really don't have any time for questions. I'm just going to read out one question, because time is up now, and we don't want to go past one o'clock. Can we just ask you Carol, who I know has some experience, a lot of experience working in South America.

America is seeing an increase in fasci. Hello. Looks like we may have lost Ian.

I'm back again. Sorry I missed that. What was that?

Question, which you may or might have an answer for, do we know which countries in South America are seeing an increase. I was, I was, yeah, I think it's places like Peru, it's up in the Andes. OK.

Points coming through from delegates who've been listening. It's one o'clock, so I'm, I'm gonna draw things to a close.