The Study of the Geography of Disease

Abstract

The study of the geographical aspects of disease dates back to the earliest of written records. I do not need to remind such a gathering as this of 'Ai s, Waters and Places* or of the other writings of classical times. Even here, however, there are still un solved problems, as I was reminded recently when I was asked to express a medical opinion on the Plague of Athens recorded by Thucydides. For what it is worth my opinion, and that of my colleagues, was that this epidemic was one of smallpox. Until comparatively recently the relationship between locality and disease was a subject of interest to many practising physicians, but the scientific developments in medicine in the nineteenth century, and especially in the field of pathology, led to the increasing absorption of the interests of medical men in morbid anatomy and histology, bacteriology, and later virology. You will, of course, be familiar with the gibe that a specialist in medicine has become one who knows more and more about less and less, but it is, I think, true to say that both clinicians and research workers became preoccupied almost exclusively with the morbid processes occurring within the human body, while the epidemiologists tended to concentrate on the case to case spread of infectious diseases. The last fifty years have seen the most remarkable changes in the effectiveness of our methods of controlling diseases and the time has come when members of the medical profession can no longer work in isolation, for the problems of the future are rather those of communities than of individuals. Tuberculosis, for example, now depends for its final eradication on action over a broad front, for the medical measures by which it can be controlled are becoming fully understood. We now live, in effect, in two worlds. There is the smaller, highly industrialized, wealthy, literate, and relatively secure type of community familiar to us in western Europe, the United States of America, and certain other countries. There is also the much larger part of the world, composed of countries still in the early stages of development, and mainly rural, where the results of the control of the great killing diseases of infancy, childhood, and early adult life, have yet to reach their maximum effect. Malnutrition, poverty, and ignorance have also to be contended with. If we are to discuss the geography of disease we must first recognize that the problems are vastly different in these two parts of the globe. It is my purpose, therefore, in opening this discussion, to sketch the broad back? ground, and to discuss certain current problems, in the hope that we may reach agreement on the possibility of cooperation between geographers and medical men and if so in what direction we should proceed.