Scot. moo. J., 1976, 21: 45
environment. It expresses a temporary state of conflict between man (his living tissues, cells and components of cells)and his environmental challenges as he tries to cope with them in order to survive. In this respect the environment may be considered as a reservoir of physical, chemical, biological and sociocultural forces which support or threaten and which, among other powers, have mutagenic properties over the genotype of all living things. The forces or factors which may place man's health in jeopardy are known as stimuli in contrast to the behaviour of man when exposed to or affected by them which may be called responses. The analysis of these two opposite terms of the equation of life can provide a theory of environmental maladjustment, of ecological imbalance and of medical geography. Medical geography is concerned with the study of those local variations of environmental conditions or stimuli which are, or may be, causatively related to human health or lack of it. Basic medical diagnostic information upon ill-health or cause of death is rarely collected in a strictly geographical sense. Place of exposure to environmental stimuli or stresses is often inadequately recorded. A primary source of information is the death certificate but this is not without its problems. Morbidity data too have their own difficulties. Censuses provide statistical information but data on birth and death rates and on fertility and infant mortality are still inadequate in much of the world. Only with this type of information can standardised procedures be applied to allow valid geographical comparisons. In contrast to the relative paucity of medical data the sheer mass of statistics concerning the various aspects of the physical, biological and socio-cultural environments threatens to swamp geographers wishing to consider all possible factors in their analyses. It is perhaps fortunate that the electronic computer, with its constantly increasing power and storage capacities, provides a tool to carry out laborious calculations while the interdisciplinary bond between statistics and geography has led to the development of quantitative methods of ...All the living and non-living constituents of the multifactorial appraisal in medical geography environment are integrated and form a functional as in other branches of geography. unit called the ecosystem.
MEDICAL GEOGRAPHY Much of the subject matter of medical geography is as old as Hippocrates and his De Aere, Aquis et Locis (On Airs, Waters and Places), and the term 'medical geography' has been current in Britain for 80 or so years since the publication of Alfred Haviland's Geographical distribution of disease in Great Britain in 1892. The Hippocratic concept of disease and the study of medical geography persisted in aetiology and in treatment until the time of Pasteur and Koch and the introduction of the germ doctrine towards the end of the 19th century. With the advent of bacteriology the mystery of infectious disease seemed to be swept away. The parasite became the focus of attention and the importance of the environment was forgotten. Bacteriology provided the new paradigm or model by which more and more disease problems might be solved. The internal milieu of the body and its balance (homeostasis) became the centre of interest and from it developed an 'introvert' attitude to disease. However, now that the most important principles of the co-ordinated function of the various human organs have been clarified and additional knowledge of molecular biology accumulated it has become possible to adopt a more 'extrovert' attitude and to focus attention on the environment in which man and communities live. It has become increasingly evident that the actual state of the human organism, whether healthy or showing pathological traits, depends not only on the equilibrium of the internal milieu but also on factors of the external environment, as well as on the complex inter-relationships of the two. Continuing this train of thought it may be said that each and every member of the ecosystem* -and this must inevitably include man-is inherently bound to the existing physical and biological environment with which it forms an organic unit. Health can thus be looked upon as ecological balance or a state of harmony within the environment. III health or disease, on the other hand, represents ecological imbalance, disequilibrium or lack of harmony within the
Leading Articles
The basic concept of medical geography hinges upon the recognition of groups of factors or stimuli significantly co-extensive with spatial patterns of health or ill-health parameters. The methodological framework for such studies within geography stems from regional analysis where relationships and interrelationships are sought, in geographical space, between disease factors. The culminating point is to recognise causation. Applied to medical problems this is aetiology. Its importance lies in identifying previously unrecognised relationships or causative factors as a preliminary to removing or controlling those factors which are, or thought to be, harmful to man. Medical geography is a tool rather than an end in itself. It is the application of geographical methods and skills to medical problems. Hopefully, comparative studies of spatial variations of disease or death occurrence and distributions of socio-economic and/or other stimuli of the environment will contribute to the understanding of those
46
conditions whose cause or causes still await elucidation. With the increasing disenchantment in medicine with an approach to disease dominated by high technology and feats of 'medical engineering' the pendulum appears to be swinging back now to a more detailed consideration of the basic factors and stimuli of the environment which operate to produce pathological conditions in man. As such the medical geographer, trained in the examination of space relationships and well versed in the interlocking system and innumerable feed-backs that constitute the man-environment relationship, can offer a valuable complementary approach to the solution of many aetiological and epidemiological problems.
G. M.
HOWE
REFERENCES
Howe, G. M. (1972). Man, Environment and Disease. Newton Abbot: David & Charles Howe, G. M., Loraine, J. A. (Eds.) (1973). Environmental Medicine. London: Heinemann McGlashan, N. D. (00.) (1972). Medical Geography: Techniques and Field Studies. London: Methuen
environment. It expresses a temporary state of conflict between man (his living tissues, cells and components of cells)and his environmental challenges as he tries to cope with them in order to survive. In this respect the environment may be considered as a reservoir of physical, chemical, biological and sociocultural forces which support or threaten and which, among other powers, have mutagenic properties over the genotype of all living things. The forces or factors which may place man's health in jeopardy are known as stimuli in contrast to the behaviour of man when exposed to or affected by them which may be called responses. The analysis of these two opposite terms of the equation of life can provide a theory of environmental maladjustment, of ecological imbalance and of medical geography. Medical geography is concerned with the study of those local variations of environmental conditions or stimuli which are, or may be, causatively related to human health or lack of it. Basic medical diagnostic information upon ill-health or cause of death is rarely collected in a strictly geographical sense. Place of exposure to environmental stimuli or stresses is often inadequately recorded. A primary source of information is the death certificate but this is not without its problems. Morbidity data too have their own difficulties. Censuses provide statistical information but data on birth and death rates and on fertility and infant mortality are still inadequate in much of the world. Only with this type of information can standardised procedures be applied to allow valid geographical comparisons. In contrast to the relative paucity of medical data the sheer mass of statistics concerning the various aspects of the physical, biological and socio-cultural environments threatens to swamp geographers wishing to consider all possible factors in their analyses. It is perhaps fortunate that the electronic computer, with its constantly increasing power and storage capacities, provides a tool to carry out laborious calculations while the interdisciplinary bond between statistics and geography has led to the development of quantitative methods of ...All the living and non-living constituents of the multifactorial appraisal in medical geography environment are integrated and form a functional as in other branches of geography. unit called the ecosystem.
MEDICAL GEOGRAPHY Much of the subject matter of medical geography is as old as Hippocrates and his De Aere, Aquis et Locis (On Airs, Waters and Places), and the term 'medical geography' has been current in Britain for 80 or so years since the publication of Alfred Haviland's Geographical distribution of disease in Great Britain in 1892. The Hippocratic concept of disease and the study of medical geography persisted in aetiology and in treatment until the time of Pasteur and Koch and the introduction of the germ doctrine towards the end of the 19th century. With the advent of bacteriology the mystery of infectious disease seemed to be swept away. The parasite became the focus of attention and the importance of the environment was forgotten. Bacteriology provided the new paradigm or model by which more and more disease problems might be solved. The internal milieu of the body and its balance (homeostasis) became the centre of interest and from it developed an 'introvert' attitude to disease. However, now that the most important principles of the co-ordinated function of the various human organs have been clarified and additional knowledge of molecular biology accumulated it has become possible to adopt a more 'extrovert' attitude and to focus attention on the environment in which man and communities live. It has become increasingly evident that the actual state of the human organism, whether healthy or showing pathological traits, depends not only on the equilibrium of the internal milieu but also on factors of the external environment, as well as on the complex inter-relationships of the two. Continuing this train of thought it may be said that each and every member of the ecosystem* -and this must inevitably include man-is inherently bound to the existing physical and biological environment with which it forms an organic unit. Health can thus be looked upon as ecological balance or a state of harmony within the environment. III health or disease, on the other hand, represents ecological imbalance, disequilibrium or lack of harmony within the
Leading Articles
The basic concept of medical geography hinges upon the recognition of groups of factors or stimuli significantly co-extensive with spatial patterns of health or ill-health parameters. The methodological framework for such studies within geography stems from regional analysis where relationships and interrelationships are sought, in geographical space, between disease factors. The culminating point is to recognise causation. Applied to medical problems this is aetiology. Its importance lies in identifying previously unrecognised relationships or causative factors as a preliminary to removing or controlling those factors which are, or thought to be, harmful to man. Medical geography is a tool rather than an end in itself. It is the application of geographical methods and skills to medical problems. Hopefully, comparative studies of spatial variations of disease or death occurrence and distributions of socio-economic and/or other stimuli of the environment will contribute to the understanding of those
46
conditions whose cause or causes still await elucidation. With the increasing disenchantment in medicine with an approach to disease dominated by high technology and feats of 'medical engineering' the pendulum appears to be swinging back now to a more detailed consideration of the basic factors and stimuli of the environment which operate to produce pathological conditions in man. As such the medical geographer, trained in the examination of space relationships and well versed in the interlocking system and innumerable feed-backs that constitute the man-environment relationship, can offer a valuable complementary approach to the solution of many aetiological and epidemiological problems.
G. M.
HOWE
REFERENCES
Howe, G. M. (1972). Man, Environment and Disease. Newton Abbot: David & Charles Howe, G. M., Loraine, J. A. (Eds.) (1973). Environmental Medicine. London: Heinemann McGlashan, N. D. (00.) (1972). Medical Geography: Techniques and Field Studies. London: Methuen
