Histories of Health in Southeast Asia: Perspectives on the Long Twentieth Century

Histories of Health in Southeast Asia: Perspectives on the Long Twentieth Century

by Tim Harper

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Health patterns in Southeast Asia have changed profoundly over the past century. In that period, epidemic and chronic diseases, environmental transformations, and international health institutions have created new connections within the region and the increased interdependence of Southeast Asia with China and India. In this volume leading scholars provide a new

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Health patterns in Southeast Asia have changed profoundly over the past century. In that period, epidemic and chronic diseases, environmental transformations, and international health institutions have created new connections within the region and the increased interdependence of Southeast Asia with China and India. In this volume leading scholars provide a new approach to the history of health in Southeast Asia. Framed by a series of synoptic pieces on the "Landscapes of Health" in Southeast Asia in 1914, 1950, and 2014 the essays interweave local, national, and regional perspectives. They range from studies of long-term processes such as changing epidemics, mortality and aging, and environmental history to detailed accounts of particular episodes: the global cholera epidemic and the hajj, the influenza epidemic of 1918, WWII, and natural disasters. The writers also examine state policy on healthcare and the influence of organizations, from NGOs such as the China Medical Board and the Rockefeller Foundation to grassroots organizations in Thailand, Indonesia, and the Philippines.

Indiana University Press

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Histories of Health in Southeast Asia

Perspectives on the Long Twentieth Century

By Tim Harper, Sunil S. Amrith

Indiana University Press

Copyright © 2014 The China Medical Board
All rights reserved.
ISBN: 978-0-253-01495-5


Krom Luang Wongsa and the House of Snidvongs

Knowledge Transition and the Transformation of Medicine in Early Modern Siam

Nopphanat Anuphongphat and Komatra Chuengsatiansup

By the end of the seventeenth century, Ayutthaya, the Siamese capital, along with Melaka and Hoi An, had already become regional centers of trade and commercial exchange. Located on an expansive Chao Phraya River with its maze of interconnecting waterways, the entrepôt of Ayutthaya, known to the European as the "Venice of the East," spawned barges and ships from the high seas as well as sampans from local canals. During its glorious days in the reign of King Narai, the Court of Siam at Ayutthaya was frequented by Portuguese, Dutch, English, and French visitors. They were traders, missionaries, and diplomats who brought along not only new commodities, new religions, and new contracts, but more importantly new knowledge. It was the time for new learning as the new episteme had called into question not only the modus vivendi that the Siamese had long held sway, but also the modus operandi in the technical domains of architecture, engineering, astronomy, and medicine.

The royal court at Ayutthaya was seemingly keen to embrace all things Western. With Constantine Phalkon, a Greek adventurer, as his counselor, King Narai received ambassadors; endorsed foreign trade; made treaties; appointed foreign consultants; enlisted Western technical assistance in design and construction of forts, palaces, and water supply systems; accompanied French envoys to witness a lunar eclipse; and provided missionary facilities to build churches and granted them freedom to preach Christianity. In medicine, Western doctors were appointed as court physicians. Records reveal that the Royal Court of King Narai had requested Daniel Brochebourde, a French surgeon from Vereenigde Oostindische Compagnie (VOC) to serve as court doctor where his descendant also served thereafter. A hospital was also founded in 1669 in Ayutthaya to provide medical care for local people. Western medicine seemed to be well received, as two hundred to three hundred people waited each day for their medicine.

Medical knowledge in Ayutthaya at the time, according to Simon de La Loubère, was nothing but primitive. La Loubère, a French diplomat and missionary, arrived at Ayutthaya in 1687 during the reign of King Narai and spent three months in Siam seemingly intruding on all aspects of Siamese life. Upon his return, he wrote a report of his magisterial survey of Siam, A New Historical Relation of the Kingdom of Siam, which first appeared in French in 1691 and in English two years later. His rendering of "an exact account of the things" he had seen and learnt in Siam described in detail the geography, history, production, cultivation, education, habits, houses, food, marriage, art, government, king, custom of the court, climate, law, and astronomy, all observed and learned during his extraordinary stay from September 27, 1687, to January 3, 1688. In medicine, La Loubère said of the Siamese,

They trouble not themselves to have any principle of Medicine, but only a number of Receipts, which they have learnt from their Ancestors, and in which they never alter any thing. They have no regard to the particular symptoms of diseases: and yet they fail not to cure a great many; because the natural Temperance of the Siameses [sic] preserves them from a great many evils difficult to cure. But when at last it happens that the Distemper is stronger than the Remedies, they fail not to attribute the cause thereof to Enchantment.

If the state of medical knowledge in Siam as described by La Loubère seemed archaic, Western medicine, which was still in its infancy at the time, was not far removed from its Siamese counterparts. There were records of medical treatments among French missionaries in which holy water and consecrated oils were used to anoint the sick in church services; these were counted on to have therapeutic efficacy.

While adopting and making good use of Western medicine, the court of Ayutthaya was not an empty vessel. Elaborated bodies of medical knowledge did exist. Records of herbal remedies and medical regimens prescribed to King Narai were found in a medical treatise with names of attending physicians and dates of prescription. The indicated dates suggested that the records were made between the third and fifth years of King Narai's reign, 1659–61, more than two decades prior to the arrival of La Loubère. The text, known as King Narai's Medical Treatise, was compiled, with subsequent additions of medical formulae from the successive reigns, to have a total of eighty-one formulae and was supposedly intended as a reference for house doctors. Among the names of physicians, however, only five of the nine doctors listed were Siamese. The others included one Indian doctor, one Chinese doctor, and two Western physicians. Medical formulae on the list also included recipes for ointments prescribed to the king by Western physicians. This significant medical text attested to the eclectic attitude of Siamese royal court towards medical practices at the time when differing ideas contended and conjoined.

Western influence at the Siamese court ended with the death of King Narai. With the fall of Ayutthaya in 1767, evidence of traditional Thai medical knowledge as well as its interaction with Western medicine was further scattered. It was not until the early Rattanakosin era that efforts to restore knowledge in various fields were seriously attempted. In the field of medicine, restoration of medical knowledge was immediately carried out during the First Reign. Medical texts and statues of hermits demonstrating meditation and exercise postures were placed and proffered to the public at Wat Phra Chetuphon (Wat Pho), near the Grand Palace. A compilation of pharmacopoeia (Tamra Rong Phra Osot) was undertaken during the Second Reign. Medical texts were collected from around the kingdom by the order of the king. In the Third Reign, stone tablets engraved with traditional medical knowledge and anatomical diagrams of massage were placed at the corridors of Wat Rajaorasaram and Wat Pho for public viewing. During this period of medical revitalization, however, King Narai's Medical Treatise mysteriously disappeared. It only reemerged some 250 years later, when Siam was attempting to come to terms with a new threat of colonial aggression in the nineteenth century.

Although most of valuable texts and official records were destroyed during the fall of Ayutthaya, King Narai's Medical Treatise survived the destruction. A copy of this significant treatise was kept by Krom Luang Wongsa, the chief physician at the royal court during the reign of King Rama III and IV. Krom Luang Wongsa was himself a renowned traditional doctor from a lineage of famous healers. During his time, however, traditional medicine was fiercely challenged by Western medical knowledge. Rather than resisting changes, Prince Krom Luang Wongsa learned Western medicine from missionary doctors. His mastery of modern medicine earned him a certificate from the New York Academy of Medicine and made him a corresponding fellow of the institute.

As the new science made its headway into Siam, Krom Luang Wongsa's family, the Snidvongs, strove to carry on its customary duty. Krom Luang Wongsa's son maintained the family tradition, became a doctor, and served as court physician. Like his father, he learned and had good command of both traditional and Western medicine. Krom Luang Wongsa's grandson, however, could no longer hold on to the family medical tradition. He forwent traditional medicine and was the first Siamese to earn a bachelor degree in modern medicine from a Western university. The story of Krom Luang Wongsa's family embodies the dynamic interplay of power, changing contexts, and contested medical knowledge in nineteenth-century Siam. It is through the family history of Krom Luang Wongsa that this chapter seeks to understand how medicine from different knowledge traditions contested each other and combined.

Royal Court Physician and the Challenge of the New Science

The arrival of Western colonialism in the nineteenth century reintroduced a Western system of knowledge to Siam, a system of knowledge far more scientific than that acquainted by the court of King Narai some two hundred years earlier. Siamese conventional wisdom that appeared to defy the logic of science was increasingly challenged. It did not take long for the Siamese elites to realize the inevitability of change and the necessity to learn new science. Among those directly affected by the winds of change were the royal court physicians. Based on a totally different worldview, the two systems of healing often came to direct conflict and it was traditional medicine that kept losing its ground to the new science. An illustrative incident was when Dr. Dan Beach Bradley, an American missionary doctor, visited Vajirayan Bhikkhu to give him a medical checkup. Vajirayan Bhikkhu (who later became King Mongkut, but was at that time ordained as a monk), suffered from a kind of "wind disease."

Upon his examination, Bradley proposed an etiological explanation of the disease and openly expressed his disagreement with folk theory. He attempted to convince Vajirayan Bhikkhu and a host of Siamese physicians that the "wind theory" proposed by Siamese doctors was indeed a hoax:

I found the poor man very much diseased. He had had a complaint in the right ear that had led to paralysis of the nerve that controls the muscles of the face.... This disease, I learned, is called "wind." It was said that it first began at the feet and gradually ascended to its present seat. It had been treated by local applications and internal medicines of a heating kind. I spent considerable time to convince the patient and physicians that the idea of "wind" being cause of the disease was all humbug.

The patient and his brother were quick to perceive the truth of my illustrations, and then labored to bring over the native physicians to the faith. The latter were not willing to give up their notion which was the main pillar of their theory. I then proceeded to show what was the probable cause of the complaint, and was happy to find that I gained the confidence of those who heard me. The patient seemed willing to dismiss the former physicians and put himself solely under my care.

Krom Luang Wongsa must have felt such challenges, for he was also serving as the royal court physician at the time. The new science might as well have aroused the intellectual curiosity of the young doctor who would eventually rise to the position of chief physician in charge of the Department of Royal Physicians.

The Life and Times of Krom Luang Wongsa

Among the Siamese elites eager to learn the knowledge of the West, Krom Luang Wongsa Dhiraj Snid was a crucial figure. The forty-ninth son of King Rama II, he was born July 9, 1808, and given the title "Phra Ong Chao Nuam." His mother was from a family of adept physicians; both of her parents were famous in traditional medical practice. They both served as royal court physicians during the reign of King Rama II. Their medical knowledge has been inherited and transmitted over generations. Phra Ong Chao Nuam joined the service as physician at the royal court during the reign of King Rama III. His service earned him the title "Krom Muen Wongsa Dhiraj Snid." During the reign of King Rama IV, he was in charge of the Royal Warehouse and the Ministry of the Interior, chief counselor to the king and, with royal bestowal, acceded to the title of "Krom Luang Wongsa Snid." He was known to be well versed in liberal arts, science, military, education, diplomacy and international affairs. In medicine, Krom Luang Wongsa Dhiraj Snid (hereafter Krom Luang Wongsa) was court physician in charge of Department of Royal Physicians during the reigns of King Rama III and IV, and his descendants also succeeded him in serving as court physicians.

As was the custom at the time, children of the royal court went through a period of study. After learning the Thai language at a very young age, young men started studying Pali as well as regal conduct and etiquette in their early teens. Between the ages of thirteen and twenty-one, they were ordained as Buddhist novices to learn monastic discipline. After leaving the novitiate they pursued further education under the tutelage of respected authorities. They also learned statecraft and royal legislative procedures by conferring in administrative affairs at the palace hall. After the age of twenty-one, they entered monkhood and spent their time learning Buddhism as well as mastering the secret art of thaumaturgy. The gentlemen were considered mature and ready to serve as courtiers only after the completion of their monastic lives.

As a novice, Krom Luang Wongsa was fortunate to have Somdet Phra Maha Samana Chao Kromma Phra Paramanujita Jinorasa, the supreme patriarch, as his mentor. Instructed by a master well versed in Buddhism, statecraft, arts, and literature, Krom Luang Wongsa was subsequently known as a man of multiple talents. Krom Luang Wongsa inherited the medical knowledge from his maternal family and he had been concocting medications for his father, King Rama II, since his teens. At the age of thirty-four, King Rama III appointed him the chief of court physicians in charge of the Department of Royal Physicians. It was an important position, for the department was responsible for life and death of all the royal families.20 To ensure they could take on the responsibility, all court physicians needed to be meticulously appraised.21 Jean-Baptiste Pallegoix, vicar apostolic of Eastern Siam (1805–62) who resided in Siam during the reign of King Rama III and IV recorded in his journal the story of the court physician:

There is a chief mandarin for all royal doctors. The latter are divided in several groups providing the service in turn. They must be on guard in the palace day and night to give care to patients of the court. They accompany the army, princes and mandarins on their journeys. All doctors receive salary from the King and their dignity passes to their children.

Krom Luang Wongsa's medical prowess was well established. After a single year of serving as royal court physician, one of the most beloved daughters of King Rama III was placed under his care. His exceptional skill was so impressive that it was praised in a famous poem, "The Illness of Krom Muen Upsorn Sudadhep." One verse read,

The Chamberlain's medication was indeed fit for the task.
Shortly after taking, [the patient] was merrily in good mood.

In 1850 King Rama III fell seriously ill. Krom Luang Wongsa was duly in charge of caring for the King. The ailment had become untreatable and the King died the following year. When King Rama IV ascended to the throne, Krom Luang Wongsa was once more entrusted to carry on his duty as the chief physician in charge of the Department of Royal Physicians.

The Exposure and Espousal of Western Medicine

Krom Luang Wongsa was no stranger to Westerners; most foreigners in Bangkok at the time were well acquainted with him. An article in the Illustrirte Zeitung, a news magazine published in Germany, described Krom Luang Wongsa's friendly character as follows:

Krom Luang Wongsa Dhiraj Snidh, Prince of Siam, was a brother of the reigning King.... He is wealthy and generous. He owns, for instance, several ocean steamers in a business he operates. Although outwardly he might appear difficult to approach, he is in fact truly good natured and hospitable, especially to his European friends. He always allows visitors to borrow his steamers. Recently, he received Mr. Commerzienrath Wolf, a visitor from Gladbach, and let him use the steamer free of charge. Besides, whenever he is free from his duty, he always permits foreigners audiences and provides assistance when they are in need.

Sir John Bowring, the British Ambassador who came to negotiate a treaty with King Rama IV, upon learning that the King had appointed Krom Luang Wongsa to chair the treaty commission, wrote in his records,

The King nominated his brother, the Prince Krom Hluang Wongsa, to the Presidency of the Commission; and he could not have made wiser choice, for the prince has had much intercourse with foreigners, among whom, as with the Siamese, he is extremely popular. His influence was undoubtedly flung into the balance of an emancipating and a liberal policy; and I have reason to believe he had no sinister interest likely to prejudice or mislead.

In fact, as a man well versed in diplomatic affairs, Krom Luang Wongsa was in many instances appointed chief officer in the negotiations to amend treaties with European powers during the reign of King Rama IV.

Krom Luang Wongsa's interest in Western medicine probably sprang from his interaction with his many missionary friends and his favorable attitude towards Western civilization. Townsend Harris, the American envoy who negotiated the treaty between Siam and the United States during King Mongkut's reign in 1856, noted, "From there we called on Krom Luang Wong [Sa] Tirat Sanit, the King's brother and Chief Physicians to the royal family.... He spoke about the Siamese being a jungle people, and not so advanced in civilization as the nations of the West." This self-deprecation could well be a tactical maneuver in the game of diplomacy. But his keen interest in Western knowledge, especially Western medicine, was unmistakable.


Excerpted from Histories of Health in Southeast Asia by Tim Harper, Sunil S. Amrith. Copyright © 2014 The China Medical Board. Excerpted by permission of Indiana University Press.
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