MG - Perspectives, Practitioners and Themes

Ancient Greeks - Hippocrates (a greek doctor) - (460BC) Presumed contributor to Corpus Hippocraticum which is a collection of work covering various medical topics, concerned with geographical variables in disease causation (climate, site, location)

Leohard Ludwig Finke - "first" to use term 'medical geography. First to refer to a map of diseases, although does not include actual map in book. Friedrich Schnurrer 1820 - First actual map of global distribution of diseases

Pioneers in Germ Theory - Louis Pasteur (1822-95) and Robert Koch (1843-1910)

Paul, B, M (1985) Approaches to medical geography: a historical perspective

• The study of medical geography officially began in the 18th century
• 'Disease ecology' is the oldest approach to medical geography
• Maps: Dotmaps - "The dot method was used in the cholera maps to depict the localized epidemic pattern". Progress maps - "Progress maps were also used to illustrate the epidemic's flow along the inland waterways. These were relatively small scale maps"
• Renaissance of medical cartography after the second world war
• The World Atlas of Disease, published by the American Geogrpahical Society uder the direction of May, represents a major landmark in the disease mapping of the twentieth century

Led the tranformation of medical geography after the 2nd WW. Founder of medical geogrpahy with a focus on disease ecology. Trained medic.Involved in the creation of the AGS atlas of diseases, which was created because of disease becoming a concern to the US military in WW2, with the soldiers going all over the world. It was called the Seuchen Atlas..

May, J (1950) Medical geography:its methods and objectives. Argued that there are 5 main pathogens that effect the spread of disease:

• Caustive agents (e.g. viruses, bacteria, protocoa)
• Vector (e.g. flies, lice, ticks, mosquitoes)
• Intermediate hosts
• Reserviors e.g. bats being infected but not affected
• Man

3 main geographical factors that affect the spread of disease:

• Inorganic stimuli (climate, relief, soils)
• Organic stimuli (e.g. vegetable life, animal life)
• Socio - cultural stimuli (e.g. population distribution, density, standard of living)

Has J.M.May borrowed M.Sorre's 1933 concept of Pathogenic complexes (Akhtar,R,2003)

• Until now it was believed that J.M.May's 1950 paper that provided the framework that helped remove the obsticles in the medical geogrpahy tradition placed by Louis Pasteurs germ theory
• M.Sorre stated in 1933 that his paper provides a conceptual and methodical framework of research in medical geography
• Sorre's book of 1943 contains a number of world maps showing the distribution of breeding place, great endemic regions, and the distribution of filariasis, bilharziasis, leishmaniasis and rickettsiasis

6 years of military service in WW2

Age 17, entered employment with the Bank of Scotland

1940's - became a full time geography student at Edinburgh University

1950, Assistant lecturer at Liverpool University

Experience in Tropical medicine where much of his work focuses on the ecology of Malaria 

Particularly interested in the Malaria cycle

Malaria- Caused by protozoan - single celled animals of genus plasmodium

Reflections on the regional geography of disease in late colonial South Asia

In the late colonial period rainfall and relief patterns virtuall represent a kind of back cloth for the whole picture of health and disease.

The semi-arid zone

• Great variations occur in harvests, bringing alternations of relatively plenty with lean years or actual famine, often accompanied by epidemics of disease spread by insects, water and man.

The Himalayan zone

• The few himalayan districts afford glimpes of a far from favourable picture, with a depressing complex of low standards of material life and health, poor nutrition, liability to severe epidemics of cholera, to endemic or epidemic malaria, and to diseases of poverty, backwardness and ignorance like leprosy.

The unsatisfactory conditions under which most townsfolk live are vital in the maintenance and spread of tuberculosis.

Humboldtain Representations in Medical Geography

• In the 19th century the geographic location, the contors of distribution and the connections within the physical environment of a particular disease were for the first time indicated on maps
• "Maps suggestively connected the causes of disease with their geographic occurance"

Three stages in the development of representation in early medical cartography:

• The textual map - Distribution indicated by words and short sentences on a conventional geographic map that showed the outline of the worlds continental masses. Few, if any, patterns of distributionand interrelationships of disease with physiography emerged
• Contoured maps - Lines, different types of shading, colours and such like codes partially or totally replaced the written word to convey information about the occurance of diseases, in this way, areas of distribution emerged and systematic connections appeared
• The use of isotherms - The zonal distribution of diseases was emphasized and the connection with climate made tighter than can be effected by the use of straight latitudinal lines. They can be used as boundary lines to indicate the limits of diseases

Susan Cannon remarked: the use of isolines characterised the studies by naturalists who worked in tradition of Alexander von Humboldt Muhry (A German physician, 1810-88, who used isotherms in a lot of his work) who had an aim to scientifically upgrade and reform medicine by intergrating it with physical geography of Humboldt.

Humboltian cartography was cosmopolitain and yet by no means free from national prejudices

It contributed to a world view that was crudely Eurocentric, glorifiying Europe's geographic features and climate, the health of it's inhabitants and the preeminence of its culture

History, definition and problems of medical geography: A general review

History

• Start with Hippocrates "Airs, Waters and Places"
• The Germans have made an extensive contribution, so have the English, French and Americans

Definitions

• One of the first: 1795 - L.L.Finke of Lengerich
• Proposed definition: Parasitology, epidemiology, and medical entomology take into consideration some aspects of the relationship between disease and environment. Medical geography professes to make the study of these relationships its principle objective

Pathogens of communicable diseases and related ecological problems

• The causitive agent of a disease can be introducted in the human body directly e.g. epidemic meningitis and cholera (inhaled, ingested or introduced through wounds or abrasions)
• In other instances the causitive agent is introduced in the human body through the orifices of a vector
• Vertibrates other than man may serve as a habitat for an infective agent, help support its life cycle, and at the same time increase its numbers

Pathogens of noncommunicable diseases and related ecological problems

• Studying how temperature, altitude etc. effect the geographic pattern of distribution of degenerative diseases such as goiter, hardening of the arteries, arthritis, and cancer
• The American geographical society is now engaged in studies in studies of the geographical pathology of cancer
• National Cancer Institute in Bethesda, Maryland, has set up a unit of geographical pathology
• Reported that pulmonary cancer does not exist in Iceland and Korea and that pancreatic cancer is common in Finland

Background

• BSc Geography
• Interested in disease ecology but in the context of urban environemtns and also in mental health
• Many studies in spatial epidemiology
• Tended to work with practising medics

Schizophrenia

• It is widely recognised that people are genetically predisposed to Schizophrenia. But these attacks can be brought on by a number of triggers
• Interested in what sets off these attacks in the social environment
• Found that most cases in Nottingham are in the city centre
• Ecological fallacy - Just because an area has a characteristic such as high Schizophrenia doesn't mean everyone there has it

The distribution of Schizophrenics in Nottingham

• In 1962-63, half the hospital beds in England and Wales were occupied by the mentally ill or subnormal, but expenditure by the National Health Service on their patients amounted to only 12.5% of the total
• A dot map was used to signify the patients and their addresses
• Results: Most of the Schizophrenics in the present sample were first admitted from addresses in or near to the city centre
• 68% of the patients lived within 4km of the city centre at the time they were sent to the hospital
• Also studied different catagories of people such as male/female, foreign-born etc.

The causes of Schizophrenia

• No scientific evidence for a single cause of Schizophrenia
• Traditional view that genetic and biological factors are primarily responsible for the emotional disorder
• Correlations between Schizophrenia and low social and economic status
• Many research workers are moving towards what L Bellah terms a multiple factor theory of Schizophrenia
• An absence of so called advantages in life, such as a stable marriage and high income, may diminish the human capacity to adjust

In 1980 John Giggs undertook a study on Acute Pancreatitis in Nottingham and attempted to find a link between these cases and the environment, either social or physical

The results were compared with the spatial variation of the domestic water supply and AP but it is not proven that this is the cause.

Background

• Interested in heathcare service provision which was most prominant between 1970-1980
• His earliest work was in the utilisation of GP surgeries in South East Wales
• Researched how patients would travel long distances to a GP instead of going to the local GP
• Why? Larger surgeries are favoured by people of higher economic status
• Personal mobility
• Keeping a previous GP after a move

Hong Kong

• Also studied Hong Kongs dramatic changes in infant mortality, which reflects the physical environment
• In 40 years deaths from infectious and parasitic diseases has gone down by 20%
• But there has been a rise in mortality from cancers and heart disease

Behavioural survey of attendance patterns at general practitioner services in West Glamorgan

Household questionaires were conducted in three randomly selected pairs of sites. The pairs were made up so that only one factor is different - such as the social class being different but age structure and access to similar GP facilities is the same

Findings

• In the west cross survey area, 50% of low status respondants attended their nearest surgery, whilst only 21% of high status respondants attended their nearest surgery
• Even though low status people are expected to be less personally mobile, good cheap bus routes allow them to travel out of the city
• High status respondants are more likely to visit the nearest but largest surgery
• Personal mobility - even if a household owns a car, not every adult in that house may be able to drive and/or have access to the car in the daytime
• 84% of low income status respondants attended their surgery by public transport
• Age did not seem to have much of an effect
• Low status moves may be much shorter in distance than a high status move of house, so therefore it is easier for a low status respondant to retain an original GP in a previous area of residence.