Disease in the Southeast Asian Past

Knowledge of disease in the Southeast Asian past is severely constrained by some of the same features that give the region its uniqueness. Human remains, and written records of disease, deteriorate rapidly in the acid soils, heat, and humidity that are characteristic of this part of the world. This lack of sources would, in itself, constitute a major difficulty in the study of the history of disease in Southeast Asia. However, the cultural diversity of the region also raises other issues fundamental to the interpretation of the past. For our purposes, paramount among these is the question of differing perceptions of disease.

Following Arthur Kleinman (1987), the term "disease" will be used here to include a wide range of explanations or perceptions of illness. Unlike plants and animals, most diseases are not so readily distinguishable by common features. Not only do peoples differ in the ways in which they group the various symptoms of illness into diseases, but there may be considerable variation in the types of bodily phenomena that constitute symptoms. Conditions such as the enlarged spleen associated with malaria may, among some populations, be regarded as nonpathological (Ackerknecht 1946). With other peoples, much emphasis is placed on whether symptoms are located in the upper or lower part of the body and the time of their onset in relation to the phases of the moon (Ohnuki-Tierney 1981; Mulholland 1987). In some cases there may even be little distinction made between disease and the agent that causes it (Schafer 1967). As a consequence, available descriptions of illness often do not provide the type of information that is necessary for biomedical diagnoses to be made.

Information on illness in the Southeast Asian past comes in several forms: In addition to what may be regarded as indigenous classifications, there are Indie, Chinese, and early Western systems of classification. It is possible, for example, that a case of diarrhea might be seen as "internal heat," "an expansion of the heat element," "fluxes," or as a "normal" phenomenon, depending on the source of the description. Furthermore, as Norman Owen (1987) has indicated, a feature of the Southeast Asians' response to disease was their syncretism. An appropriate diagnosis and treatment was selected from among the various systems available. For this reason, a history of disease in Southeast Asia is, in part, a history of the ways in which illness has been classified in this region of the world.

This is not to say that biomedical interpretations are not possible. In past accounts one can recognize many of the diseases that were known in the region until quite recent times and, in a large number of cases, are still prevalent in the region today. Malaria, smallpox, dysentery, cholera, typhoid, typhus, plague, leprosy, beriberi, goiter, trachoma, respiratory diseases, tuberculosis, and parasitic and helminthic infestations are but a few examples. However, although it is often possible to interpret accounts of illness in terms of our modern understanding of pathology, this approach reveals only one aspect of the history of disease in Southeast Asia. Neglected is the place of disease in the context of extra- and intraregional dynamics involving trade, warfare, politics, and culture. In short, biomedical interpretations do not show how Southeast Asians perceived disease and what it meant to them.

Another difficulty in treating the history of diseases in Southeast Asia as a whole is posed by the number of different ethnic groups and languages in the region. This problem is further exacerbated by the diversity of languages and methodologies of the available secondary sources on the subject. For this reason, although the general features described will relate, in the main, to the history of diseases in the whole of Southeast Asia, the specific illustrations given in this essay will be taken mainly from mainland Southeast Asia. In particular, a good many examples will be drawn from the Thai peoples.

There are several reasons for this narrow focus. In part it reflects this writer's own area of specialization, a situation that is unavoidable in approaching such a topic. In addition, however, the history of disease among the Thai peoples is an appropriate focal point for a study of the disease in Southeast Asia. The region of mainland Southeast Asia where the Thai kingdoms developed in many ways represented a meeting place for the major civilizations of Asia, lying between China to the north, India to the west, and the Austronesian peoples to the south and east. Originating in the north, the Thai, who were "syncretizers" par excellence, moved into a region already occupied by Mon and Khmer peoples. Furthermore, although the kingdom of Siam came to dominate the other Thai "city-states," it was alone among Southeast Asian countries in remaining uncolonized by Europeans. On the other hand, it may be argued that, though not directly colonized, Siam was a de facto colony, in that its development during the late nineteenth and early twentieth centuries was mainly in the hands of European and American advisors.

Previous historical studies have not, in general, taken advantage of the opportunities that mainland Southeast Asia presents for the examination of disease. The processes of adaptation, perception, and response to illness have, for the most part, been examined in the context of the colonized regions of insular Southeast Asia. This is to be expected, in view of the ready availability of information on disease, and the size of the populations in these areas, with their concomitant health problems. But in using illustrations from uncolonized mainland Southeast Asia, this chapter seeks to redirect some of the emphasis in the study of the history of disease.

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