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With under four million people, Connecticut ranks in the lower half of the list of population by state (at 29th).  It is also the third smallest state in geography; only Delaware and Rhode Island are smaller.  If measured, however, by the proportion of academic historians of Vietnam to the population or geographical size, it’d probably rank first among fifty US states and ten Canadian provinces.

The most recent hire is Nu-Anh Tran at the main campus of University of Connecticut.  The others began their jobs in the 2000s at three of the four directional branches of the Connecticut State System. They are Bradley Davis at Eastern Connecticut State; Wynn Gadkar-Wilcox at Western; and C. Michele Thompson at Southern.  Should one urge Central Connecticut State to complete the cycle by hiring a specialist in Vietnamese history?

This small but not insignificant concentration translates to approximately one historian of Vietnam for 900,000 people in Connecticut. It’s not a bad ratio at all.  True, there isn’t one such at Yale. (It does have an anthropologist of Vietnam in Erik Harms.)  But Southern Connecticut State University is located in the same town, and a news station in New Haven could easily reach Michele Thompson should it look for such a specialist to offer a historical perspective on current events about Vietnam.

The historians at the directional schools have produced quite interesting monographs on Vietnamese history.  Their specializations are subfields and periods other than the Vietnam War: a welcoming development of Vietnamese history in the U.S.  Their emphases also vary.  Prof. Gadkar-Wilcox, an intellectual historian, published his first book on debates about and manipulation of Vietnamese history during the eighteenth and nineteenth centuries.  He has recently completed the manuscript for his second monograph: an intellectual history about the imperial examination from the nineteenth century to the early twentieth.  Just last week, I learned that Prof. Davis, a specialist on the China-Vietnam borderlands, has published his book about the Black Flags in the nineteenth century.  Last but not least, Prof. Thompson published her monograph on medical history just a little over a year ago.  Not surprisingly, all three historians deal extensively with Sino-Vietnamese relations.

The last book is called Vietnamese Traditional Medicine: A Social History (Singapore: National University of Singapore Press, 2015).  The straightforward title and subtitle are telling; as her in-state colleague Gadkar-Wilcox rightly notes in his review, “English-language studies of the history of medicine in Vietnam are comparatively rare, as are social histories of Vietnam prior to the 20th century.”  Below is an interview that I had recently with Michele Thompson. 

Tuan Hoang: Having known little about the subject, I much enjoyed reading the book.  The first chapter introduces readers to Sino-Vietnamese connections regarding medical knowledge up until the early nineteenth century. It shows there were exchanges between the Chinese and the Vietnamese, not one in which Vietnamese learned from Chinese only. One example is the “gift” of the Vietnamese physician Tuệ Tĩnh to the Ming court in the fourteenth century.

Among other things, this chapter suggests that prior to the early nineteenth century, China did not influence Vietnamese medical knowledge as much as its rulers liked to claim.   Much of this chapter discusses the example of smallpox, including the issues of (a) smallpox variolation, and (b) the fetal toxin theory. Even though Chinese physicians favored the fetal toxin theory for six centuries, and even though the theory was introduced to Vietnam, it did not catch on among Vietnamese physicians at all.

I have two questions related to the first chapter. First of all, in term of the medical history, how would you situate this book within the historiography about modern Vietnam?

Michele Thompson: One of the major questions in Vietnamese studies, whether modern or premodern, is the breadth, depth, and quality of the influence of China as a political entity and of the waves of culture that have come to Vietnam from the geographic space that is now China. This question can be, and has been, examined from many angles. For example, in Beyond the Bronze Pillars Liam Kelly uses envoy poetry as one of his major sources and mixes diplomatic history and literary studies in his approach to this question. My book is the first in English to examine medicine as one element of the millennia long cultural relationship between Vietnam and China.

Smallpox & Gia Long’s quest for a vaccine

Second, what are the reasons that you focus on smallpox for this study? Why not, say, tuberculosis? Or malaria? Or cholera?

This is discussed in detail in the section “Why Smallpox” in the “Introduction.” However, to try and boil this down to a brief answer for readers of your blog.  While tuberculosis, malaria, cholera and many other diseases have all been with humankind for thousands of years, these are essentially modern disease categories. Thus it is difficult when looking at older texts, certainly anything pre-twentieth century, to be certain that what is discussed is the same disease that might today be called malaria, tuberculosis, or cholera.

Because of the extremely noticeable manifestations on the skin produced by smallpox it is one of the few diseases that appears in ancient texts with a similar description to that one might find up until the second half of the twentieth century when smallpox was eradicated.

My other reasons for using smallpox are essentially dependent on the first. For one thing I needed a medical problem that I was certain occurred in both China and Vietnam and that occurred in the same form in both places. Because smallpox is comparatively easy to identify even in ancient records I could be certain that my authors were discussing the same problem, in the same form, in both places.

Chapter 2 moves sharply into the reigns of Gia Long and especially Minh Mạng. In story-telling, it is the most delightful chapter of the book.  There is the “court story” about factions and intrigues, especially among three sides: Minh Mạng; the physician Jean Marie Despiau; and the mandarin Philippe Vannier and Jean-Bapstiste Chaigneau.  There is the “international story” because it involves France, Macao, Manila, plus Huế and Đà Nẵng. Then there is the story of the search for a smallpox vaccine. All three stories are tightly connected, adding to the delight of reading about them.

Let’s start with Gia Long. You note that there were many unfinished projects at the time of his death in 1820. Why was the smallpox vaccine one of his projects?

Smallpox was a disease that caused so much havoc that it often had really serious economic consequences. Pretty much all rulers at the time, all over the world, were interested in vaccination for smallpox once they heard of it. So you can say that Gia Long was interested for economic and political reasons. Besides that though, on a personal level, Gia Long had experienced family tragedy related to smallpox himself when his eldest son and heir, Prince Canh, died of smallpox. By the time he first heard about vaccination, the summer of 1819, he also had grandchildren who could be spared the potential ravages of smallpox through vaccination.

How much (or little) progress did he make by the time of his death?

Unfortunately the documentation on this is not very clear at all. I am certain that he had heard of vaccination for smallpox, from the ship’s doctor of the Henri, which I discuss at length in the book. Further, it is clear that Gia Long knew that vaccine was available in Macao and he probably also knew that it was available in Manila.

However, you must remember that he was already pretty ill when he got this information. Gia Long’s illness was the real reason that the physician from the Henri was invited to the court. It was only about 6 and a half months after this that Gia Long died. So it is really not surprising that he did not complete sending the mission himself.

You note that Gia Long “maintained fairly close contact with both Macao and Manila” during his reign. Why these two locations?

The Nguyễn had had pretty close relations with Macao for a long time before Gia Long was even born. They had bought arms and ammunition from Macao since at least the 17th century. Gia Long maintained that family connection. As for Manila, two of the Europeans who had served with Gia Long’s forces, Jean Marie Dayot (sometimes spelled d’Ayot) and his brother Felix moved to Manila after Gia Long became emperor.   They acted as commercial agents for the Vietnamese court there. So there was a personal connection he could, and did, use.

Of course Gia Long and the Vietnamese court tried to have relations with many different polities of the time. I made the statement about “these two locations” Macao and Manila because of their connection to the introduction of vaccination to Southeast Asia, I did not intend to imply that these were the only two places where Gia Long and his court had connections.

Minh Mạng, Nôm medical writings, and the Nôm tradition

Turning to Gia Long’s successor, he distrusted Vannier and Chaigneau because, among other things, they had opposed his succession to the throne as decided by Gia Long. He entrusted in Despiau for the transportation of a vaccine to Vietnam. Moreover, he sought to restructure the court medical establishment. Minh Mạng was quite conservative in changing the medical establishment at court. He began, for example, to ban the use of the Nôm writing, including Nôm medical writings.

Vietnamese medical writings in Nôm are among the most important primary sources of this book. Can you tell us the significance of these sources in understanding the Vietnamese medical tradition?

I don’t think that you can understand anything about Vietnamese Traditional Medicine if you don’t at least take into account the existence of texts in Nôm. Of the remaining texts over fifty percent are at least partly in Nôm and so if one ignores them one is ignoring over half of the texts that were produced in Vietnam by Vietnamese authors. I think that my insistence, since 1994, on the importance of Nôm in areas well outside literature may be the most important contribution of my work to the wider field of Vietnamese studies.

If I had the most fun reading Chapter 2, I learned the most from Chapter 3. I also found Chapter 4 (plus the last ten pages of Chapter 3) the most fascinating portion of the book.  Why?  Because Chapter 4 describes the persistent usage of Nôm among Vietnamese practitioners of traditional medicine.  One reason for this persistence is the indigenous tradition of pharmacology.  Another is the fact that only a very small amount of healers entered the Nguyễn medical service, and therefore continued to write in Nôm beyond the scope of Minh Mạng and later emperors.

Are there other reasons for the continuity of Nôm medical writing after Minh Mạng?

What I am about to say flies in the face of all of what is usually taught about Nôm. It appears to me that there were a number of people, healers of various sorts, who were at least partially literate in Nôm but were not literate in Chinese. They probably learned it at home, as was still usually the case in the early twentieth century, and they may not have known how to read and write much beyond the names of plants within local materia medica but they did know that. It was usually part of a family tradition and, after all, Nôm could represent what one might think of as hyper -local names of places and other items of local interest as well as local names for plants. These people would have been way below the radar of the Court.

The Nôm tradition came to an end in the twentieth century. There are many factors that contributed to the end of this tradition, including the promotion of the quốc ngữ script and the advocacy of Western medicine by the colonial authorities. Nonetheless, the remarkable fact remains that the Nôm tradition persisted as long as it did. What factors contributed to the usage of Nôm during colonialism (and even past it)?

Tuan, if you mean the Nôm tradition in medicine came to an end in the twentieth century then I think that one can say it did. There were still a few Vietnamese healers who used Nôm, for at least some of their medical writings, in the 1990s. But if there are any left today who really use Nôm rather than just knowing it, they are very very few in number.

Some factors that I know contributed to the continued usage of Nôm in medicine, even after its use had become rare in other situations, were its flexibility in terms of representing local dialects and local names for items of materia medica in the Vietnamese medical chest. Another was the lack of opportunity for the majority of the rural population in Vietnam to acquire formal schooling, which would have been in quốc ngữ [the modern script] or French, during most if not all of the colonial period. This meant that whatever writing a child learned was the one its parents could teach it.   Among the rural population of healers that was as likely to be Nôm as it was Chinese and both were more likely to be known by literate adults than Romanized Vietnamese was.   I’m sure there are also other factors and this is a subject which is really worthy of further study.

One very interesting that I learned in Chapter 3 is on different attitudes towards “folk medicine” understood by Chinese and Vietnamese physicians at the time? Generally, why did Chinese physicians label some medical practices as “rural” or “folk” – that is, they rather looked down upon them – while their Vietnamese counterparts regard them as standard?

Historically, the practice of medicine all over the world has been divided by socio-economic class. In turn upper versus lower class was often associated with literacy, or the lack thereof, in the recognized language and writing system of a given polity. Comparing China and Vietnam, by the 18th and 19th centuries (the time period my book concentrates on) in China there was a much longer history of an elite scholarly tradition of medicine which was, to some extent, defined and regulated by the Chinese court and its bureaucracy. Those outside this system were often regarded as folk practitioners. This level of royal involvement in training and employing physicians for government purposes did not become a major factor for practitioners of Vietnamese Traditional Medicine until the Nguyễn.

The sheer number of healers who entered the medical service of the Nguyễn was pretty small, but they were influential and, perhaps, more importantly a defined path of advancement had been created as had a system of recruitment which favored those in the upper classes and those literate in Chinese. In my book I argue that because of this, under the Nguyễn, the practice of medicine in Vietnam became more stratified than it ever had been before. However, this was a process that took several generations and before that time there was much less stratification than one could see by the very early colonial period. Thus, in Vietnam there really was no ‘folk’ versus ‘recognized’ in medicine until a later period in time than in China.

More on smallpox

All right, one example is the different views on smallpox variolation, not only between Chinese and Vietnamese, but also French practices. Let’s start with China… The Chinese tradition developed from folk healers and, by the sixteenth century, had been refined and standardized by elite members of the medical community. The Vietnamese, on the other hand, did not seem to be aware of variolation before 1825.

What might have accounted for the divergence between Chinese and Vietnamese medical communities regarding variolation and the fetal toxin theory? Why, in this case, didn’t the Vietnamese find the theory acceptable? Moreover, you note the Vietnamese emphasis on an external agent regarding smallpox. How much an impact did this emphasis produce regarding Vietnamese unwillingness to accept the fetal toxin theory? Why, in short, such “dissonance” as experienced by the Vietnamese medical community?

I think that this hinges on the Vietnamese response to the entire theory of ‘fetal poison/toxin’ as being the root of not just smallpox but also of other childhood diseases such as measles. For reasons that are completely unclear to me, even after all of my research into this subject, the Vietnamese do not seem to have been very interested in this until at least the 17th century, and most of them were still not intersted then. For example, in the mid 17th century the famous physician Lãn Ông does discuss fetal toxin in his texts.

But, as the work of Leslie de Vries has shown, Lãn Ông was quite sinified in his approach to medicine. I would not say that the Vietnamese rejected fetal toxin theory, I have found no text that specifically argues against it, but they do not discuss it much either. In my book I argue that the Vietnamese seem to have had a preference for external agents as causes of diseases such as smallpox although they certainly considered that many health problems had a cause that was either internal or what today would be called ‘lifestyle’ problems.

I further argue that this preference for an external causative agent of smallpox may have produced some intellectual dissonance on the part of Vietnamese traditional physicians when they were introduced to the theory of fetal toxin as the cause of smallpox.

Why did the Vietnamese turn to Chinese-style variolation during the 1820s or 1830s? In particular, why did they turn to this kind of variolation after Despiau came back to Vietnam with French vaccine?

[Actually] Despiau did not come back with French vaccine. There was no such thing. Vaccination was invented by Edward Jenner who was English. By 1820 vaccination had spread around the world although the vaccine was also lost many times in many places. Despiau got his vaccine from Macau, which had gotten it originally from a Spanish expedition. Macau had lost its vaccine upon occasion and then been resupplied from the Philippines-which had also first acquired it from the Spanish expedition.

 Teaching, research, and a story about Trần Quốc Vượng

A few times in the book, you recall observations made during your research and visits to Vietnam. Would you share one or more anecdotes about your experience of living in Vietnam during your research in the 1990s: people, institutions, travels, unexpected research discoveries (if any), etc.?

My goodness, that was such a wonderful period of my life! I really hardly know where to start, especially since my anecdotes are usually inspired during the course of a face-to-face conversation. There were so very, very many people who helped me, many of whom have remained close friends, I tried to remember all of them in my acknowledgements.

For an unexpected research discovery that I am currently working on, I can give you a brief anecdote about the late great Professor Trần Quốc Vượng. Professor Vượng was unbelievably helpful and kind to me the whole time I lived in Vietnam and for many years after until his sad death in 2005. He provided me with much that was totally unexpected and one of the best lessons I learned from him was to realize that often, in Vietnam, I didn’t even know the right questions to ask.

He also had the habit of somehow answering a question I asked him with an experience that might come days, weeks, or even months after I asked him so I had to learn to be patient about getting ‘answers.’  At one point I asked him if Vietnam had had any kind of a public health system before the Colonial period. He didn’t give me much of a reply he just said “yes and I will show it to you later.” ‘Later’ turned out to be months later when I was accompanying Vượng and several other archeologists on an expedition out in the countryside to inspect several digs and see how things were going there.

We also stopped at a lot of other places that were of interest for one reason or another. One of them happened to be a large but mostly closed Buddhist pagoda (most of them were still closed in the early and mid 1990s) where Vượng led me to a very overgrown enclosed area that looked like it might have once been a garden. Parts of it had been re-dug and were being tended again but most of it was not. Vượng said “This is it” and he waved his hand at the whole enclosed area and at another building away from the main structure of the pagoda on one side of the ‘garden.’ Quite stupidly I said “This is what?” Vượng said, “You asked about the public health system and this was it. Every Buddhist pagoda had a medical garden, most had monks and nuns trained in healing, and that building there was a sort of hospital where the really ill could stay.” We then spent an hour or so with Vượng and others showing me plants still growing there that had medicinal uses and discussing this whole subject of Buddhism and health care.

I would never have even thought to investigate Buddhist institutions and persons as ‘the’ public health system of Vietnam before the Nguyễn without this experience that Vượng gave me but I hope that an investigation of this subject is going to be my next monograph.

Do you mind sharing with us some thoughts your teaching of this topic at Southern Connecticut State University? How much if any content on Vietnamese traditional medicine have you incorporated into your undergraduate and graduate courses?

While I have certainly incorporated some, there are so few students here who have any background in either History of Vietnam or History of Medicine that I have not incorporated as much as I would like to.

One area where I can do this is where History of Medicine in Vietnam intersects with Environmental History. A lot of students are interested in environmental issues and so discussion of how those issues affect the plants, animals, and even sources of minerals that form the bulk of Vietnamese materia medica is of interest to them. Wider environmental issues affecting Vietnam and most of Southeast Asia are also an interest of mine, and these are easy to work into class readings and discussion.

This is the third in the series “Interviewing Historians.”  The first is on Jay Veith’s book on the fall of Saigon; the second on Kurt Kinbacher’s research on Vietnamese refugees in Lincoln, Nebraska.