November 2014

In 1982 I purchased a copy of Benjamin Smith Barton ’s writing Collections for an Essay towards a Materia Medica of the United States (3vols, Philadelphia, 1804).  In this book he made a statement about a geographical disease referred to as James River Ringworm which first appeared in slave populations residing on lands owned by Thomas Jefferson’s family.   


This led me to pose a series of research questions, which 30 years later I was finally able to answer.  These questions were . . .


1) What exactly was the James Fever Ringworm?


2) Was it truly an endemic or epidemic disease like Barton suggested, or short lived?


The cause for James River Ringworm was important to because I decided it was either a result of the living conditions that slaves had to endure, or it was due to the transport of this disease from Africa.  In a lengthy, very drawn out review of this "epidemic" for the VIrginias, I learned that it was also related to a disease that appeared along the shores of other nearby rivers according to French writer Louis Valentin, ca. 1796-1805.  It also appeared to be very much wilderness related, could it have also been zoonotic in nature?  


By a simple probabilities map of the region, using spatial concepts to define the different ways this disease may have evolved, I came up with several theories as to how it made its way to the region.    

By reviewing basic transportation routes for the time, population densities for the slave camps, the places where it existed and their natural ecology, I was able to determine where the disease prevailed the most, and more importantly what it’s probable cause was based on physical geographic and climate-weather features.    


Several times a year I am contacted about my study of this epidemic history.  Currently, historical microbial pathology specialists are frequently turning to past research and writings to determine if the fungal diseases noted today as new to a region are in fact simple a rediscovery of these past regional disease patterns.    


In particular, the complications of post surgical patients healing and recovery processes due to local fungal and bacterial contamination of slow healing organ transplant and ulcer injuries seem to be linked to, of all things, soil chemistry and the way soil plays such an important role in spore production and infection of open sores and wounds.  Of all places, this is a primary research endeavor by a colleague of mine at a Long Island teaching hospital dedicated to high technology research in the medical sciences.   


When I began this research in 1982, I had no reason to pursue it much, until the realization that there was certainly a topography and climatology reason for this purportedly regional epidemic pattern.  The diagnosis I came up with for James River Ringworm was very amusing once it became clear which one of the four species most likely responsible for it was the probable cause.  We missed this obvious clue to a cause for this epidemic impacting Jefferson’s slaves due to our modern interpretation of this disease.  Jock Itch or Athlete’s fungus took on a very different appearance when it first appeared as an epidemic during the early years of Virginia Colony and United States medical history.


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“There are two reasons for this year’s measles resurgence in the US, according to a recent paper in the New England Journal of Medicine.

The first is that the virus is still rampant in other countries, where it remains a leading cause of death in children. Globally, more than 20 million people still get measles each year, and about145,700 of those infected died in 2013 — an alarming increase from the previous year. Americans who travel can’t completely avoid contact with measles in many countries, but with high vaccination rates and effective infection control procedures in place, the disease can be kept at bay in the US.


That’s why the second reason for the resurgence is so troubling. “An increasing number of parents in this country are hesitant to have their children vaccinated,” the authors, from the Emory University School of Medicine, explain. “Such hesitancy has resulted in an accumulation of unvaccinated populations who can become infected and maintain transmission.”


There will always be a small number of unvaccinated people, namely babies who are too young for the vaccine and people whose immune systems are too compromised for a vaccine to be effective. Under the best circumstances, those people are protected by herd immunity: when the vast majority of a population is vaccinated, the virus cannot spread and will fail to reach the vulnerable few. But the “accumulation” the Emory researchers refer to is “non-medical exemptions” — parents who cite religious or philosophical objections to vaccination, artificially increasing the ranks of this vulnerable group and putting those who can’t make a choice, like infants, at unnecessary risk.


I think it’s going on three years that I have been posting this piece of public health news.  


My review of the national population health statistics for "refusal to immunize children under 5" received a considerable amount of resistance from the medical profession.  My matching posting on examples of diseases that are immunized and where they are noted as part of a patients medical history in this country, drew the criticisms of leaders in some of the grander leadership positions in the epidemiological field.    But facts entered into EMRs don’t lie (some are rule outs, some are history, some are mistakes), and millions of accidental entries seems very much impossible.


This observation of avoiding the childhood immunization program I first made in 1986 when I was a researcher of taxol and several novel cancer drugs, in Portland State University’s chemistry department.  At the time, I was also teaching classes on health and medical chemistry.  My chemical specialty was and still is alkaloids and toxicology.


Friends in my age range in the late 1980s had kids who they refused to immunize.  This was very much a by-product of the natural health movement going on around this time, but soon escalated into the vaccinations are unsafe ideology, due to the published claim that autism could be linked to certain vaccines. 

(At one point in time, the mercury in the measles vaccine was claimed to be linked to autism, a claim since reversed and the supportive findings retracted by the researcher who performed this study; it was subsequently denounced in the medical journals and literature, but is still believed in by many people today).


Ten years later, when I had the opportunity to begin researching the health of the population using GIS and spatial data, this is one of the first topics I evaluated–the distribution of immunizable diseases in young children, and the EMR claims that included V-codes indicating a refusal to immunize you child.  


Each of the immunizations that is refused has its own V-code.  A single immunization can be in combination form, but there is an independent v-code for each line of combos or single vaccination products that is refused.   A mother that refused to let her child be given an MMR for example was of course counted for each of the 3 vaccines refused.  This allowed me to differentiate refusals by type of immunization, to determine if measles was the primary disease being avoided for its vaccine products.  


When I first produced these maps, I was completely surprised about how universal these refusal patterns were, with parents preventing immunization of their children across all immunization products, both single and combination products, not just involving the individual measles vaccine or the MMR.


This behavior continues to day, and over the years the videos I produced of the maps of these behavioral pattern have remain unchanged in their spatial findings–the Pacific Northwest has the greatest numbers and density of children lacking the complete immunization profile by the age of 5, and the lower Hudson Valley into New York City has the greatest population density of children lacking a full immunization history.  


This was also the first evidence I then publicized, for arguing that my very fast program for mapping national disease (nationalpopulationhealthgrid project – NPHG) is in need of further use and experimentation in a real life big data world.  (Which I am still searching for, for my PhD dissertation project).


needless to say, there is a tremendous amount of resistance against my national population health mapping technique.  I admit, it is not as standard and cut and paste as the other GIS systems everyone is heading towards.  However, this is the only effective way to produce 15 to 20 thousand maps per day, or dozens to hundreds complex 3D maps, enough maps to quantify the health of the entire nature for hundreds of metrics per program run.




Should the reader wish to explore my unique innovation, the child immunization  presentations are at the following: 


Immunizations and other childcare health issues demonstrated using the NPHG program are presented at this  YouTube page: 


My Pacific Northwest Regional Health research report (1987-2006) also details this aspect of regional health, and more, at 


My criticism on much of the public health profession and managed care industry about its slow adoption of GIS in healthcare administration and management is reviewed–pointedly and in its entirety–at 





For those with just a few minutes to check out this issue, I recommend my 3.5 minute video on where the diseases are noted in the medical records, and a series of videos on the refusal for each vaccine type.  These videos very succinctly makes my point – – THE HERDING EFFECT IS AN OUTDATED IDEOLOGY OR PARADIGM that has to be put away when dealing the healthcare of a modern/post-modern society.   See this at 


Or via (for the written text introduction page), 




My general review  from years ago of immunization refusals has the following YouTube index (links to an old YoutTube site, inactive, but most videos are still running):



Refusal of Childhood Immunizations (all combined) —
Immunizations for Diseases —
Refused Variola —
Refused Measles —
Refused Mumps —,
Refused Rubella —
Refused Diphtheria —
Refused Tetanus —
Refused Pertussis —
Refused Polio —
Refused Viral Hepatitis —
Refused Typhoid —
Refused Tuberculosis — 




Other related pages/presentations/poster sessions/etc.:    


A third party information page supporting my postings: 


ScoopIt! on the new mapping algorithm I developed–NPHG: 


A NLM article on the pacific NW problem, particularly in Seattle – – 




“Great spirits have always encountered violent opposition from mediocrity.”


Albert Einstein, 1940


"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident."


Arthur Schopenhauer



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The immigration policies of the Obama administration and the democrats in Congress have opened the door to another disease, Dengue hemorrhagic fever that is now


Dengue is literally one of dozens of foreign born diseases that make their way into the United States on an irregular basis.


The fact that we hear about this now surprises me, since this has been a public health issue since the large migrations into this country from the south began.  Dengue is mosquito borne.  So once the winter kicks in its travel to new places will be significantly hampered.  


Dengue, like most fevers, is distinguishable from other conditions brought on by mosquitoes.  It has not penetrate the northern latitudes of the U.S. as much as west nile.  Its common vector is Aedes aegytptii.  There are other Aedes species of mosquitoes in the United States however.  


Some of my first disease ecology mapping engaged in out in the field involved the studies of west nile.  My documentation of Aedes in a county in NY by trapping is illustrated in one of these early ArcView GIS maps I produced back around 2002/3 .  The page covering species distributions is 


This work I did on West Nile between 1999 and 2006 was actually quite extensive.  The innovation I demonstrated was the role of canopies and sunlight behavior/exposure on vector species distributions, by species and risk for a given region for west nile.  These pages are frequently reviewed by students learning the disease ecology approach to surveillance.  For the best of the pages, perhaps go to my work on the use of light sensor measures around trap sites: 


Remote sensing and NLCD/Satellite imagery were two other avenues I explored for West Nile surveillance.  ( and 😉


In 2002/3, I demonstrated the value of GIS when the team I was working with used it to find the hot spot for positive testing crows ( ); this was followed by the discovery of an ecological setting where west nile virus overwintered. 


Back to Dengue – – – the following is a link to a 3D Videomap map of this ICD’s past behaviors:   


Interstingly, the disease, also known as Breakbone fever, has a local NY plant known as Boneset that was a diaphoretic used to break the fever in these cases during the late 1700s/very early 1800s.   The presence of Boneset (Eupatorium perforatum) and this legend on its use is a strong indicator on the local history of Dengue Fever in the upper-Mid-Atlantic states as well (A native American remedy purportedly, but with laboratory testing demonstrated in the medical school setting as early as the late 1790s).  Therefore, it was not restricted to the warmest climate settings in U.S. medical history. (My 20+ years of research on this topic as well, is partially initiated at — it has dozens of pages).



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These four maps demonstrate one of the most controversial things about disease mapping.   Sickle Cell is a disease strongly linked to Slavery history.  It is less correlated with other African or African American cultural features such as Muslim in-migration communities, international African missionary program locations (some ICDs are strongly associated with these due to special humanitarian programs) and contemporary African American cultural behaviors and features.


This begins my discussion of examples of how to apply these maps to contemporary research, using the Mixed Model or combined qualitative-quantitative research approach to evaluating population health. 


The two cultures most in need of this Mixed approach right now are the Hispanic/Latino and African American/black/negro groups.

There is a very important argument that population health monitoring leads many of the critics to.  When, if at all, does this procedure violate HIPAA?  


How does grid modeling actually correct for this problem through a  change in spacial parameters and region or place definitions?  


Traditional GIS using standard base maps enables zip codes, towns and census and voting blocks to be linked to the data–this link is expressed in the data used to produce the map.  


When grid mapping is used (like my NPHG method), you eliminate that ability to link a diagnosis to a particular site as we know it.  To know a particular case is from a particular town or hamlet, you have to know as well that the areas next door are lacking these cases.  No healthcare professional or expert in a disease knows with absolute certainty where every case resides in a region, not matter how much he/she thinks the program knows, since it is the "expert" in the field.


In other words, the likelihood for a "mile away" example, that people often forget, is always there.


The two maps on the left depict a special formula I used to evaluate Sickle Cell carrier identification. (The IP process converts the numbers to relational concepts, a method more useful today when analyzing certain disease patterns and mimics the prevalence methods always in use).   When IP maps and numbers maps are close together, the result is a very strong spatial association in terms of magnitude.    


The maps on the right depict where the African Americans were residing during the slavery period in U.S. history, and how African American households are distributed today.    


There is a mid-Atlantic density for carrier traits situated along the densest population density region in the U.S..  This is either due to population density itself or the primary in-migration routes for slaves early in U.S. history.  Virginia, the heart of slave trade and in-migration early on in U.S. history, remains the center of the carriers for this genetic trait.   


The isolated high peaks along the west coast demonstrate a more recent outcome due to socio-cultural behaviors, situated in fairly small, perhaps even isolated African American communities.     


This map brings up two ideas for a qualitative-quantitative research of African American diseases patterns.  Are the East coast social aspects or variables similar to the same for the west coast?      


If we were to select several small communities on the east coast, and compare each to the single isolated community on the west coast, will latitude (north versus south) differences be detected that are distinct when compared to the west coast patterns?    


We know that the southern belt, stretching from Mississippi to Florida, has social, cultural and health and human behavior differences when compared with the Atlantic states.  Do statistically significant differences exist between these two regions as well?    


For researchers and students – – my mixed methods pages are :     

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These are historic disease maps of the United States, depicting its natural disease patterns based on the local climate, latitude and topography.  These maps were produced by  Heinrich Berghaus, 1846,  Adolph Muhry, 1856,  Alexander Johnston, 1856,  William Aitkin, 1872,  John C. Peters, 1877,  and Robert W. Felkins, 1888.


These six maps represent a period in medicine when the philosophy for disease began with the notion of climate and topography, an easy to imagine offshoot of the traditional "miasma" theory often ascribed to diseases during the antebellum history period (a period of perfecting medical climate and topography mapping ca. 1825, to the advent and final acceptance of the bacterium and bacterial theory ca. 1890.)   

I produced extensive reviews of each, the links of which are in the paragraphs or brackets below.        

UPPER LEFT:  The earliest of these maps is Heinrich Berghaus’s ‘Planiglob zur Übersicht der geographischen Verbreitung der vornehmsten Krankheiten, denen der Mensch auf der ganzen Erde ausgesetzt ist’,  (Camerini, 2000, translation – ‘Planisphere toward a survey of the geographical distribution of the principal diseases to which man is exposed over the whole world’.  Heinrich Berghaus (😉 was a geographer and atlas illustrator rather than a physician.  He  applied many of the teachings of his important predecessor Friedrich Schnurrer, the first regional disease cartographer (‘Charte Uber die geographische Ausbreitung der Krankheiten’, 1827; at ), and Dr. Carl Friedrich Canstatt, author of ‘Handbuch der medicinischen Klinik’, and producer of the first comprehensive disease taxonomy focused on climate, weather and the natural elements as causes   ( ).   


UPPER MIDDLE:  Adolph Muhry’s map,   [ ]  Muhry’s map is difficult to read and interpret at first.  But par for the time, it is hand watercolored in my version , contained in ‘Die Geographischen Verhaltnisse der Krankheiten oder Grundzuge der Noso-geographie ‘ (The Geographical Relations of Diseases, or Outlines of Noso-Geography).  Muhry continues along the line of the first most famous medical geographers like Schnurrer and Berghaus.  Isolated from Great Britain’s Alexander Keith Johnston to some extent (due to medicopolitical rivalry and egos to some extent), it is interesting to compare the maps of these two.       


UPPER RIGHT:  In terms of fame, Alexander Keith Johnston (😉 stands alongside John Snow (no personal page links) and William Farr (😉 when it comes to advancing the field of medical geography in Great Britain.  A geographer and cartographer, not a physician, he had a way of polarizing himself at times with others in the medical profession.  He produced the most valuable maps on disease published in English for the time ( ), and managed to improve upon the past belief that latitude was important to disease patterns and behaviors, by related disease patterns to his global isotherm charts (his portrait and presentation to the Epidemiological Society in London are at ).   


LOWER LEFT:  Aitkin’s map [  ] is a product of his work on the outbreak of diseases like typhoid due to poor sanitation during the  Crimean War (1853-6) ( ).  Aitkin, along with founder of the modern nursing professional Florence Nightingale, worked to re-gain the .respect of the Royal Armies by improving our understanding of sanitation and disease and implementing new programs that in turn led to the Hygiene and then sanitation movements.  Aitkin referred to himself as a hygiologist, and was an expert in hygiene and medicine.   


LOWER MIDDLE:  John C. Peters Maps [several pages, but begin with  ], are unique in that Peters was one of the last of the highly devoted disease topographers of the late 19th century.  Most curious is the fact that Peters began his career in medicine as a mixed-allopath-homeopathic physician, which was a very common profession during the 1830s and 1840s.  He published the most progressive journal on homeopathy, but when he noticed the homeopaths beginning to behave anti-allopathy and against upgrades or changes in the philosophy to better meet the time, Peters detached himself from this class of physicians, about 1846, and headed in the direction of medical topography.  He produced one of the most comprehensive works on the mapping of disease, especially cholera, in his life time.   


LOWER RIGHT:  Robert Felkin’s maps [  ]  and related book, "On the Geographic Distribution of most Tropical Diseases",  [  ] ,  focused primarily on the most important regionally defined, parasitic or organismal diseases, spread mostly by vector and/or animal host.  Felkins unique attributes included his masonic and strong missionary background, and his philosophy towards African races residing in the less-developed regions of the world (early "scientific racist", see ).   


DISCUSSION.  An important progression to note here is the slow change from regional diseases, mostly defined by symptoms, which are linked mostly to place and climate (Schnurrer) and later climate and topography (Berghaus and Canstatt), to most climate-defined and occasionally regionally or culturally disease zones (Muhry and Johnston), to very specific epidemic patterns and even regionally defined differences in these patterns based upon climate, topography and peoples’ lack of sanitary behavior (Aitkin and Peters).     


Felkins work (1889 – and😉 represents an early example of disease regionalization based upon organism distribution and ecology (worms, flukes, schistosomiasis, fungi, etc.), vectored disease patterns with unidentified causality (malaria, dengue, cholera), and regional foodways diseases (beri beri, scurvy), to name a few.  His claim to fame however was his belief in the magnetic force of the earth as a possible cause for inexplicable diseases, a theory developed and promoted by Robert Lawsen, Esq., Deputy Inspector-General of Hospitals  ( ).   


For another helpful site on medical cartography history, see the Princeton site: 




John Snow’s map is not a world maps, so is not covered here.  For more on Snow, the following sites are recommended:   


Medical Journal Article.     

Howard Brody, Michael Russell Rip, Peter Vinten-Johansen, Nigel Paneth, Stephen Rachman. Map-making and myth-making in Broad Street: the London cholera epidemic, 1854.  THE LANCET • Vol 356 • July 1, 2000    


Why did he have such an impact?    


Edward Tufte’s take.    


UCLA site with one of several versions of his map as jpg.    


Images (so many people have duplicated his work!)    

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Richard Preston’s “The Hot Zone: A Terrifying True Story” has sat on my shelf for the past 20 years. And though I haven’t cracked it since reading it last in 1994, I knew exactly what I would find when I opened the book again Friday.


Just an observation . . . .    


When Middle Eastern Respiratory Syndrome [MERS] made its way into the early May 2014 ( ), it only traveled about 7000 miles as the bird flies.  That doesn’t include any side routes the planes and passengers took.    


As the bird flies, the longest route from a foreign country (that is occupied) to Chicago is approximately 10,500 miles, heading from Western Australia to Chicago.  


Many of Australia’s little know diseases are those that are animal born.  That animal might be livestock in nature, marketed as a pet, or present as a refugee on board.  The common Australian diseases to strike the US tend to be like Australian Equine Fever.     


When we consider the Ebola distribution, the distance it has to travel is very close to that of MERS.  Ebola however is more latitude-defined, its ecology more limiting than the same for MERS.      


To better understand disease flow patterns in the Chicago area, I developed some videomaps on common diffusion patterns for a disease.  See:     


Chicago Disease diffusion patterns —  (four ways that diseases theoretically diffuse in and around Chicago)


African Disease patterns around the Great Lakes  — 


African Disease Patterns, entire U.S. —  (other global migration diseases, from other parts of the world, are covered on this page as well)


Australian Disease Patterns, entire U.S. — 


The EMR records of all diseases from other countries, merged onto one dataset- –






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Stats on visitors at my Blog site.

This site began as my CV while searching for work.  I converted it to the site where I post my past work, research findings, and teaching notes on medical geography, historical medical geography, managed care, cultural medicine managed care design, qualitative-quantitative research methods, medical history, the history of plant use in medicine, medical anthropology, etc., etc.

Total views since 3/2009 = 228,380 — total viewers, about 142,250 (1.5 page views/viewer).

58.2% of these Visitors were for the Medical Geography pages.

My most frequently visited page is my home page – – 13,017 views, 67 months.

The most views on a single day ever was 2,587.

Top 5 Countries are:  US, Canada, UK, India, Australia

In terms of the hexagonal grid method I developed . . .

During the past four years, 4,684 have explored the descriptive page on this methodology and reviewed the algorithm (mostly students).

About 48.5% of them downloaded the spreadsheet with the formula, for use in GIS exercises, projects and teaching.   Several sent emails of thanks and are now in the work place.

Canada geographers are more exploratory with the hexagonal grid method than US geographers, based on numbers of visitors and emails received.

More stats below.

RANK — TITLE OF PAGE VISITED   —   Number of visits

1 — Central Mexico Disease Geography (ca. 1880)  — 5,578

2 — 1851 – 1917, Cattle Drives and Texas Fever   — 5,432

3 —  Small Pox and the Cree  — 4,755

4 — Hexagonal Grid Analysis — 4,684

5 — Combined Qualitative-Quantitative Research Methods  — 4,372

6 — The Coldens’ Flora – A Taxonomic Review  — 3,752

7 — Caribbean and African Medicine in the Hudson Valley  — 3,692

8 — Late Trapper Medicines (ca. 1825-1850) — 3,519

9 — Rituals and Sainthood   — 3,229

10 – Cholera on the Oregon Trail (Thesis)  — 3,048


12 – Early Western Travels, 1810-1850 — 2,727

13 – Four Prussian Diseases (ca. 1880)    —  2,570

14 – “The James Way” of Raising Turkeys — 2,538

15 – DOWNLOAD Hexagonal Cells Excel Spreadsheet  — 2,276

16 – Explorers and Plants, Part 2, Assigning Meaning — 2,221

17 – Pinta, Yaws and Bejel (ICDs 103, 102 and 104)   — 2,116

18 – History of Discovering New World Plants — 2,029

19 – Historical Disease Maps   — 1,929

20 – 1890 – The 1890 Census Disease Maps — 1,901

RANKING OF COUNTRIES – TOP 25 (descending)

1 — United States — 104,176

2 — Canada — 9,354

3 — United Kingdom — 8,160

4 — India — 5,567

5 — Australia — 3,753

6 — France — 3,272

7 — Germany — 3,185

8 — Philippines — 2,071

9 — Brazil — 1,983

10 –  Italy  — 1,598

11 – Netherlands — 1,492

12 – Mexico — 1,376

13 – Spain — 1,316

14 – Poland — 1,269

15 – Russian Federation — 1,248

16 – South Africa — 1,177

17 – Indonesia — 1,092

18 – Thailand — 1,090

19 – Malaysia — 1,028

20 – Korea, Republic of — 937

21 – Pakistan — 893

22 – Turkey — 853

23 – Sweden — 745

24 – Belgium — 674

25 – Denmark — 670


Total Number of Visits from 3/2009 to 10/2014  =  228,388

Views per Visitor = 1.5

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