Medical Geography in India and Pakistan

1am honoured by the invitation to address the Society, which is doing so much to foster the study of medical geography, and under the chairmanship of Professor Dudley Stamp who has long been interested in this field. I have attended two lectures in this hall by Dr. Leslie Banks, Professor of Human Ecology in the Uni? versity of Cambridge, during which he depicted on a broad canvas the differing disease patterns in the developed, as compared with the under-developed or (as we hope) the developing world. My task today is to approach from the geographer's point of view some aspects of medical geography in the Indian sub-continent?a study, then, within the under-developed part of the world, in which data are some? times lacking or inaccurate. We are sure, however, that death-rates and birth-rates are still high as compared with those in most parts of the developed world, but that death-control is tending to occur markedly earlier than birth-control. Within the sub-continent of India, using only some relatively accessible and not very accurate data, I shall try to establish whether or not this problem occurs in regionally differentiated patterns of spatial distribution and of trend over time. The first part of this talk consists of a number of colour photographs, illustrating that there are differing patterns of disease-association in different types of human settlement and in differing environments within even a part of the sub-continent, Mysore State, which I know reasonably well. Dr. Learmonth showed a number of colour photographs, to illustrate points elaborated below; it has only been possible to reproduce in the Journal the four black and white photographs between pages 20 and 21. With the aid of these photographs we have this afternoon visited several Mysore villages and one urban slum, with widely varying health conditions. In the coastal region of Mysore, in which a settlement pattern of linear dispersion is typical, we have seen the relatively good health and nutrition in a fishing and in a rice-growing village. The fisher-folk are subject to some mosquito-borne filariasis; and seasonally there is stress during the stormy south-west monsoon when fishing is impossible. The rice cultivators live nearer to breeding-places of Anopheles fluviatilis and were subject to malaria until recent years. But both communities are relatively free from widespread outbreaks of intestinal disease, since each house has its own well. This is true also of the Malnad region?the wet, forested hill country around the Ghats Edge?but the alignment of the houses within the edge of the woodland does make for a perennial attendant population of house-flies and constant sapping by dysentery (plate 1). Until recently this has been an area of severe hyperendemic malaria carried by A. fluviatilis, breeding in forest streams. And respiratory diseases are heavy in places, possibly because of stress in the long, wet season. In the black cotton soil country, a compact village of flat-topped and mud-walled houses has been subject to severe epidemics of plague?now in retreat?and of influenza, particularly during the pandemic of 1919, also to famine or near-famine. The embanked and excavated tanks for drinking-water and the masonry step-walls are both guilty of continuing the endemic transmission of guinea-worm. Here and in the next village there is high mortality in the cool season from pneumonia associated with universal diseases like measles and bronchitis (plate 2). In the rolling granitic country farther south

Economic geography · Geography · Regional science · Socioeconomics · Sociology · Global Health and Epidemiology

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