Geography History and Background

Much of Korea's epidemiological past has been shaped by its geography. The country occupies a peninsula south of Manchuria that is separated from the Chinese mainland to the west by the Yellow Sea, and from nearby Japan to the east by the Korean and the Tsushima Straits. Forming a land bridge between northern Asia and the islands of Japan, Korea has time and again been subjected to invasions by armies from the Asian mainland intending to attack Japan, or by Japanese armies establishing a base from which to attack the Asian mainland. Undoubtedly, these contacts must have brought infectious diseases to Korea.

To discuss diseases of antiquity in Korea means to discuss those illnesses that occurred during the Old Choson Period (traditionally dated 2333 B.C. to A.D. 562), and the Three Kingdoms Era encompassing the Kingdoms of Koguryo (37 B.C. to A.D. 688), Paekche (18 B.C. to A.D. 660), and Silla (57 B.C. to A.D. 935), as well as the Koryo Era (918-1392). By the ninth century B.C., rice-cultivating Bronze Age cultures had been established on the Korean peninsula. During the Three Kingdoms Era, the Chinese writing system was adopted by the courts in order to ensure the writing down of state chronicles. Only fragments of these texts have survived by being incorporated in the Samguk sagi (History of the Three Kingdoms), which was compiled in 1145 and constitutes the oldest preserved history of Korea.

The introduction of Buddhism to Korea from China during the fourth century A.D. increased contacts with the Asian mainland. Particularly during the Three Kingdoms Era, many Korean Buddhist monks studied in China and were responsible for the influx of many aspects of Chinese culture to the peninsula. When, after long periods of warfare, the Three Kingdoms were unified in 661, the resulting Kingdom of Unified Silla extended cultural and economic contacts with China. Besides an increasing number of Buddhist monks, students interested in Confucian learning went to China. Some Buddhists even reached India, endeavoring to study their religion at its source. This period also saw increasing cultural and economic exchange with Japan, and commercial intercourse with Arab traders.

Although Korea was epidemiologically not as isolated as Japan, and the development of immunities within the population must have set in earlier and more intensively, the long periods of unrest, poverty, and famine during the wars of unification must have favored the outbreak of epidemics and famine-related diseases. Social reforms during the Koryo Era (918-1392) may have improved this situation. Relief programs, sponsored by the government and by the Buddhist church, were implemented; granaries were built as a precaution against years of drought; infirmaries were created; and a system of medical care in the countryside was established. Despite all these efforts, however, the vast majority of the population stayed in poverty and, consequently, remained particularly vulnerable to contagious diseases.

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