These two contributions to the study of medicine in modern Cambodia agree that there was a lack of practical and explicit interaction between indigenous and foreign (modern, French) medicine in twentieth-century Cambodia. They disagree, however, over the reasons. In Cambodians and their doctors, Ovesen and Trankell argue that ‘French-promoted healthcare’ in colonial Cambodia failed because physicians and policymakers lacked ethnographic knowledge about indigenous medical traditions (p. 43). They likewise attribute deficiencies in postcolonial efforts to build a modern system of public health to the lack of understanding and accommodation of fundamental elements of indigenous medicine. According to Ovesen and Trankell, medical ethnography can provide a solution to these historical failures. Like Cambodians and their doctors, Au's Mixed medicines is also predicated on ethnographic evidence; but rather than offering a solution to the failed interactions of modern and traditional forms of medicine in colonial Cambodia, it revels in the failure. For Au, a comprehensive historical ethnography of Cambodian medicine does not resolve the lack of practical and explicit engagement with French colonial medicine: it explains it.
Cambodians and their doctors is an empirical work. The authors abstain from engaging with literature in the fields of medical and historical anthropology (and likewise comparative historical analysis) in favour of ethnographic detail (p. x). They present their ethnography in a revisionist posture. Contra scholars who emphasise the role of colonial bureaucratic practices in fostering and reifying ethnic and class antagonisms in Indochina, the authors argue that the latter were a real feature of precolonial life, arising from ‘repeated experiences of differences in mentality, sociality, and habitus’ (p. 41). Chapter 4 suggests that documentary biases in the historiography of the Democratic Kampuchea period (1975–79) have resulted in a gross overstatement of the lack of modern medicine under the Khmer Rouge. But the real argumentative foil of the book is ‘peasant resistance theory’, specifically the argument that Cambodians refused French medicine as a means of resistance to colonial power. Au's earlier work (‘Indigenous politics, public health and the Cambodian colonial state’, Southeast Asia Research, 14, 1 [2006]: 33–86) is a favourite target of Ovesen and Trankell in this respect (pp. 43, 71–3).
The value of Cambodians, which is based on intermittent periods of fieldwork dating back to 1995, lies in its detailed social ethnography of indigenous medical practice in the second half of the twentieth century. Chapter 5, for example, contains a comprehensive taxonomy of ‘healers, spirit mediums and magic monks’ along with the nature of their calling and practice (pp. 133–5), while copious field notes introduce individual practitioners. Chapter 6 offers a similar account of the social role and status of Khmer indigenous midwives (pp. 186–201). Ovesen and Trankell make the case that French colonial policymakers — and likewise academics — misunderstood the prominent place of ritualistic and psychological aspects of healing (p. 166), and the ‘spiritual’ as opposed to merely ‘technical’ work of midwives (p. 199).
In the way of cultural ethnography, however, Cambodians fails to move beyond generality and abstraction. The authors construct an image of Cambodian medicine as a monolith, which is depicted in stark contrast to modern biomedicine. They constantly emphasise the totalising nature of the ‘Khmer indigenous health cosmology’, which they contend is distinct from a ‘medical system’ — an idea rooted in biomedicine (p. 6). The Cambodian ‘health cosmology’ is predicated on ‘the maintenance or restoration of the physical, social, and spiritual balance, which is the necessary precondition of diseaselessness’ (p. 6). Ovesen and Trankell argue that it is precisely a lack of understanding of this holistic system of health and the accompanying curative practices that have hampered attempts to introduce biomedicine and create a successful system of public health in Cambodia.
For all the care it takes to describe Khmer medicine as a ‘system’ located within a comprehensive social and cultural world, Cambodians shows very little interest in the place of disease within that world. While Ovesen and Trankell emphasise the importance of social relations in caring for the diseased, they presume a cultural ideal of diseaselessness, without interrogating the origins of that ideal — i.e. whether diseaselessness is truly a cultural ideal in traditional Khmer medicine, or whether it is an assumption borrowed from Western biomedicine and the worldview of the ethnographer. Au's Mixed medicines, by contrast, with its focus on ‘differing epistemologies’ and ‘cultural insolubility’ is more readily equipped to deal with the possibility of a fundamental difference in the metaphysical place of disease between the Cambodian and Western cultural worlds.
Mixed medicines provides a wealth of new historical evidence pertaining to the social history and historical ethnography of medicine in colonial Cambodia, while engaging with a broad range of disciplinary perspectives — including area studies, the history of colonial medicine, postcolonial theory, and science studies. The overarching theme of ‘cultural insolubility’ boils down to the assertion of ‘differing epistemologies in French and Khmer cultures surrounding medicine and disease. These epistemologies underlie the social definition of a disease, which in part determines its appropriate treatment’ (p. 157). Beginning with the premise of irreconcilable differences, Mixed medicines offers a nuanced consideration of the ‘cultural interactions’, ‘epistemological wrangling, and wider social implications’ surrounding the Cambodian experience of French colonial medicine (p. 7).
Chapter 2, ‘Collusions and conflict’, uses documents from the Archives of the Pasteur Institute and the National Archives of Cambodia to provide an overview of French colonial efforts to institute public health measures in Indochina from the late nineteenth to the early twentieth century. Au presents interesting episodes related to the first outbreak of plague in colonial Vietnam in 1898 (p. 43) and the deployment of faulty vaccines for cholera (p. 48) and smallpox (p. 56) in order to suggest that despite ‘frictions’ among the various institutional bodies involved in French colonial medicine — including the military Health Corps, the Assistance Médicale, and the Pasteur Institutes — French officials ‘repeatedly cooperated in hiding each other's errors from the public’ (p. 40). Intertwined with this tidy but narrow argument, however, are larger points about the geography of colonial science (questioning the ‘colony as laboratory’ argument) and the role of medicine in European imperialism (medicine as a ‘tool of empire’) (p. 51). With respect to the latter agendas, Au's contributions are more tentative, limited to identifying how her evidence speaks to the theoretical concerns of science studies, without offering novel analysis. The same may be said of much of Mixed medicines, which is at its best when engaged with concrete arguments related to historical or area studies scholarship (and particularly when bounded by the confines of a given social group, as in chapters 5 and 6, on women and lepers, respectively).
Chapters 3 and 4 situate French colonial medicine in relation to metropolitan politics and the shifting agendas and discourses of French imperialism in the first half of the twentieth century. They explore the gap between ‘the language of medical intervention’ and ‘the impact of these decrees on the local populations’ as a means of questioning Foucauldian histories of colonial medicine, which assume that ‘the tyranny of public health and the tyranny of imperialism work neatly together’ (p. 96).
The section beginning with ‘plural etiologies’ (pp. 107–18) at the conclusion of chapter 4 is something of a preface for the rest of the book. It introduces the differences between indigenous Khmer and the evolving Western understanding of disease etiology, and the notion of contagion in particular. Au explores the difficulties of public education in this era. Simple translation was impossible, as traditional Khmer etiology did not have equivalent terms for ideas like ‘germ’, and diseases like the plague were unknown in Cambodia prior to the colonial period (p. 108). From the French perspective, Khmer people failed to locate these new disease threats and the etiologies of Western medicine within a properly confined (secular) sense of causation. For Cambodians — much to the ire of French medical officials — ‘Microbes and divinities, the natural and the supernatural, could both work in the world to cause human suffering and both needed to be addressed’ (p. 116).
Chapter 5, ‘Prostitutes and mothers’, is organised as a response to the idea of gender equality in precolonial Southeast Asia, a cultural trait that area studies scholars have used to support the coherence and unity of the region (for example, Barbara Watson Andaya's The flaming womb: Repositioning women in early modern Southeast Asia [Honolulu: University of Hawai'i Press, 2006], which is missing from Au's bibliography). Particularly noteworthy is Au's discussion of French attempts to recruit and educate Cambodian women to play a role in colonial public health institutions. Like her discussions of similar efforts to train indigenous médicins (pp. 68–75), Au presents substantive archival evidence bringing to light gender imbalance — and the racial politics of colonial life — through the plight of individual women (pp. 140–50).
Chapter 6, ‘Civilized lepers’, is the most successful of the book, integrating social history with Au's insistence on the ‘plural etiologies’ and ‘cultural insolubility’ of the Khmer and French medical traditions in colonial Cambodia. Au makes a strong case for the existence of a ‘Cambodian colonial leprosy’ that was distinct from (a) the modern medical phenomenon (Hansen's disease), (b) its premodern European social reality (leprosy), and likewise (c) the precolonial Cambodian disease (Khmer: chomngu khlong). This peculiarly colonial sense of the threat of leprosy was formed in the French metropole — driven by French cultural and political concerns as well as the development of the germ theory of disease and laboratory science — and subsequently deployed in Cambodia. But while developments in the metropolitan understanding of the disease ‘slowly mutated within the wider French society, in the colony the doctor existed in a social framework distinct from that of his patient’ (pp. 165–6; original emphasis). This chapter skilfully weaves social history of indigenous efforts to treat the disease with French colonial efforts based on a mentality of contagion and quarantine. However, the story of ‘Cambodian colonial leprosy’ amounts to more than just the conflict between indigenous and Western understandings of the disease and modes of social medicine. Au demonstrates that in spite of the supposed universality of Western medical understandings of disease etiology (one germ corresponds to one disease), issues of ‘[c]lass, race, and sex all played a part in determining appropriate treatment’ in the colonial social context (p. 167).
Mixed medicines will be well received by scholars of Southeast Asia for its confident and sustained engagements with central topics in the social and cultural history of modern Southeast Asia, including gender, race and class. Scholars interested in comparative colonial history and the global history of modern medicine will likewise find Au's book a useful guide to the Cambodian context specifically, and the case of French imperial history more broadly. Mixed medicines also attempts to integrate the concerns of science studies scholarship, using medicine as a lens through which to consider issues of intercultural engagement, and the relations between science, political authority and society. Au is to be applauded for her interdisciplinary agenda, and Mixed medicines will no doubt prove influential in the coming years for introducing a new analytical toolkit to historians and historical ethnographers of Southeast Asia.
As companion volumes, Ovesen and Trankell's social ethnography of postcolonial medicine nicely complements Au's social and intellectual history of the colonial period. Together they represent a significant advance in the study of medicine in Southeast Asia. However, in so far as the two books cover a good deal of the same topical and archival ground (each offers chapters on the institutional history of colonial medicine, leprosy and obstetrics), they beg for comparative evaluation. In that light, there is a Whiggish or teleological tendency in Ovesen and Trankell's work, which suggests that the failures of biomedicine in twentieth-century Cambodia boil down to issues of policy and implementation alone. The authors advocate ethnography as a tool to facilitate the indigenisation and accommodation that will help modern medicine succeed in the future. Mixed medicines, on the other hand, adopts a naturalistic stance (perhaps influenced by the ‘moral neutrality’ of the Strong Programme in the sociology of scientific knowledge) to the interaction of modern and indigenous medical thought, and withholds evaluation. Where Ovesen and Trankell advance a roadmap to a more culturally appropriate system of modern biomedicine in Cambodia, Au's work explores the confrontation of indigenous ways of life and thought with the ideas and practices that have crystallised as part of modern liberal governance.
