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Using Geographical Endoscope in Diagnosis Accordance to the Inspiring Spatial Epidemiology Model of John Snow

Updated on February 24, 2016

The Geographical Endoscope is a metaphorical expression used by the author to facilitate the understanding of the function of the GIS in medicine which is similar to the medical endoscope being the both are diagnosis tools for diseases.

'' The Author.

The Geographical Endoscope as Conclusive Evidence in Diagnosis

In Medicine, one of the main functions of the medical endoscopes is to diagnose diseases by using the endoscope to look at parts of the body that couldn’t be seen by any other way in order to get the evidences to confirm the presence of the disease based on the pattern and metrics of the status of cells and tissues or to make sure there is no evidences on the presence of disease.

In Geo-Medicine (Geographical Endoscope) the main function of the geographical endoscope is to diagnose the causes of diseases from another perspective that also couldn't be seen by any other way based on the spatial patterns and various metrics of the patients in community or in another words, Geo-Medicine reveals the blind points for the researchers and the decision makers . the geographical endoscope not only uses the medical metrics but it uses all the metrics that are related to community and environment.

Any medical theory has not become a fact or still considered as hypothesis can be proved or disproved by the outcomes of the Geo-Medicine analysis which can be considered as conclusive evidences.

The outcomes of Geo-Medicine are conclusive and represent the guide for the highest level of the decision makers in the governments and also for researchers.

Dr.John Snow explains the connection between the Germ and Cholera
Dr.John Snow explains the connection between the Germ and Cholera | Source
Dr.John Snow  took his research to the town officials and convinced them to take the handle off the pumps.
Dr.John Snow took his research to the town officials and convinced them to take the handle off the pumps. | Source
The Conclusive Evidence of Dr.John Snow
The Conclusive Evidence of Dr.John Snow | Source

The History of using Geographical Endoscope - Epidemic of Cholera

The most famous Diagnosis by the GIS was conducted by Dr.John Snow while the epidemic of Cholera in London 1850. Dr.Snow is considered to be the father of modern Epidemiology.

Many in the early to mid-nineteenth century thought that Cholera was caused by bad air arising from decayed organic matter "MIASMA THEORY".

The alternative theory "Germ THEORY". Supported by John Snow, held that cholera was caused by a germ cell, not yet identified. He reasoned that this germ was transmitted from one person to another by drinking water. Snow's germ theory was deemed "peculiar" by John Simon, head medical officer of London while Dr. Simon clearly understood John Snow's theory but he joined others in questioning the relevance of the germ theory to Cholera.

John Snow plotted the locations of the deaths on a map and found they clustered around a pump in Broad Street. When Pumps were closed the mortality was much diminished. This then helped him to formulate his theory of the spread of cholera by dirty water. These analysis were considered to be

1- The first epidemiological analysis of disease

2- The first geographical analysis of disease data

3- GIS confirmed the validity of the "Germ THEORY" and showed the causes and solutions by finding new pattern which can not be seen by any other way so that the geographical endoscope is the appropriate definition To the way the diagnosis carried out by Dr.John Snow.

Using The Geographical Endoscope Today

In 1854 the first successful diagnosis were conducted by using geographical endoscope. there was an urgent need to use the same technique to diagnose new causes of diseases. today, we live in the time of the information revolution with all its benefits to humanity such as the ease of information access, advanced technology, information exchange, the published researches, in addition to the techniques of the GIS which became more advanced and used mainly in all the fields. the capabilities of the GIS today enabled us to see any details in any part in the world with unlimited amount of data for any details.

Dr.Abdul Nabi Al-Attar, The Head of the Diabetes Unit in Al-Amiri Hospital - Kuwait Said :

’’ There is a global failure of the plans of health institutions and all the attempts to stop the spread of Diabetes. in an article published by Al-Rai newspaper dated December 20, 2014. He also stressed the inevitability of moving everyone, including the civil society and individuals in the community ’’

The Global Epidemic of Diabetes

With the rapid development in all the fields of our life the medicine,healthcare, life style, communication and information technology...etc. the medicine still not able to cure many diseases specially Cancer and Diabetes. and even not able with all the attempts to stop the the accelerated prevalence of chronic diseases such as Diabetes in the world.

Diabetes & Cholera

Non communicable disease
Communicable disease
Genetic Susceptibility, Autoimmune Destruction of Beta Cells,Insulin Resistance and environmental factors
Bacterial disease caused by a germ called Vibrio cholerae in the contaminated food or water
Risk Factors
Overweight or Obesity,physical inactivity,History of gestational diabetes, High blood pressure, history of CVD
poor sanitation, crowding, war, and famine
Chronic disease - Complex group of diseases
Easily treatable disease
The Death
Almost at the long term
Within hours
Cases every year
9% among adults +18
1.4 to 4.3 million cases.
Deaths Every year
1.5 Million
28.000 to 142.000
** Causes of Cholera & Diabetes Type 1, Type 2. ** Cases and Deaths at the Global Level. Source : World Health Organization - UN

Diabetes from the perspective of Geographical Endoscope

Diabetes is group of complex diseases and has varieties of causes and many risk factors. Dr.John Snow proved the association between the Cholera and the environment (polluted water) in his geographical model.

Several studies have shown that people with higher levels of toxic substances in their blood are at increased risk of type 2 diabetes, though a cause-and-effect relationship hasn't been proved.

Accordance to National Institute of Diabetes and Digestive and Kidney Diseases - NIH

Some theories suggest that environmental factors trigger the autoimmune destruction of beta cells in people with a genetic susceptibility to diabetes. Other theories suggest that environmental factors play an ongoing role in diabetes, even after diagnosis.

So that, the role of the Geo-Medicine is to prove the association between the effects of Environment and Diabetes using the geographical Endoscope.

The inspiring model of Dr. John Snow

Dr.John Snow is considered to be the father of modern Epidemiology. Also, he is the father of the Geo-Medicine by his model which inspired the current generation to apply the same model on the Diabetes and other Diseases by using the advanced GIS.

Approximately, 165 years between the model of Cholera and the model of Diabetes where the GIS technology and the research tools became more advanced.

No doubt that science and technology and everything became more advanced but, at the same time the environmental factors which are associated with Diabetes also became more complicated and multiple.

This table shows the conditions and challenges of each age.

Comparison between the Cholera GIS Model - 1854 and Diabetes GIS Model - 2014

GIS technology
Very advanced, Very accurate, Very Fast ,Open Sources.
Very old, Hand made
Data resources
Environmental data, Diabetes Registry, Several Surveys for for many medical metrics such as BMI, HR, BP ,Vitamin D level...etc
Registry of deaths and infections
Big scale
Small scale
Very Complex
Amount of data
Diabetes needs big mount of data
Cholera needs small amount of data
The Research tools
Very advanced
Very poor
The environmental factor
Uranium & DU and pollution
Polluted water
Solutions which will be taken based on the model
Complicated and it needs more research
Take off the pumps - On Time
The cost
Very expensive
Not expensive
Cholera & Diabetes Model

The complexity of the GIS Diabetes model

  • In the GIS Cholera model of Dr.John Snow, he succeeded to disprove the validity of the theory of Miasma and he proved the (theory of germ - dirty water) is the cause of Cholera.
  • Dr.Snow didn't need to expand the analysis out of London to reach to his conclusion.
  • There was an action taken by the town officials to take the handle off the pumps.


  • In the GIS Diabetes model there is no theory to be disproved but, there are many factors of Diabetes and the challenge was to determine which one of them is the cause of the accelerated prevalence of Diabetes because there are many factors causes Diabetes and not easy at all to distinguish the factor which responsible for the accelerated prevalence. and that make the GIS Diabetes model so complicated in diagnosis.
  • In the GIS Diabetes Model, the geographical endoscope was expanded to be used at the Global level and used also at the country level, health region level and at neighborhoods level to reach to the evidences which prove the association between Diabetes and Uranium.
  • The action which is expected to be taken is complicated and its results are unknown.

That's why the diagnosis of Diabetes is complicated.

Geographical Endoscope as a Conclusive Evidence - Cholera & Water Pumps

John Snow’s cholera map of London recreated - The Modern Version
John Snow’s cholera map of London recreated - The Modern Version | Source

Geographical Endoscope as Conclusive Evidence - Diabetes & DU and Atmospheric Nuclear Tests

The Conclusive Evidence for the association between Diabetes and Uranium/DU - Global Level.
The Conclusive Evidence for the association between Diabetes and Uranium/DU - Global Level. | Source


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