from, for example, measles and smallpox.
As far as birth saang and minor saang are concerned, there does not seem to have been any attempt made to isolate small groups of symptoms which occur frequently together, such as
diarrhoea, vomiting, and thirst, symptoms confined to a particular anatomical site, or those which tend to develop only at certain times, such as khccmao, which comes only during early infancy, and is possibly associated with the birth process or the conditions imposed during the period by the fire. Rather, we find the assumption that all children are born with a congenital disease, that it starts with an abscess in the foetal abdomen at three months, and that it can be diagnosed according to the mother’s symptoms at that time, which indicate the weekday of conception. From this, the weekday of birth is presumed to be the same. Most subsequent illnesses which affect the child are then seen to be symptoms or exacerbations of symptoms of this same birth saang.
The classification of children's diseases, on the whole, excluding parasites, la, la-ong, and lom symptoms - which are, nevertheless, tied in with birth saang and its complicating minor saang - and
abnormalities of the elements, does not go far enough to be of
significant use to the diagnostician. The concept of birth saang might easily have preceded the concept of classifying diseases beyond a
simple calendrical relationship to the days of the week. Even so, the arbitrariness of the seven day week invalidates such a system of
classification, hence the need for the alternative diagnoses satisfied by the remarks above on the interchangeability of various diseases
conceived and therefore born on particular days of the week, it takes only three steps, through birth saang in general, then children's diseases in general, to the entire class of human diseases. Similarly, if these physicians thought in terms of classifying human diseases, they did not see fit to pursue the subject of children's diseases beyond separating them from adults' diseases, distinguishing parasitic diseases, then grouping sets of symptoms, with a few variations, mostly of degree of severity of particular conditions, in categories related to the days of the week.
It may be asked how a distinction could be made between children's and adult's diseases. To which, it would not be unreasonable to suggest that most of the adults must have passed through a period of exposure to the diseases endemic to the area,
and the survivors would be immune. Thus what are seen to be children's diseases in Thailand, might easily be considered general diseases to people not made immune by early contact. Typhoid and smallpox are
examples.
The pattern of diagnosis of children's diseases discerned in the bulk of the relevant material in KPC is thus found to be of a
very elementary nature. Diagnosis is made on the basis of the symptoms of the mother when she is three months pregnant, which point to a
particular form of birth saang; and this, in turn, indicates the day of conception, and predicts the same week-day as the day of birth, by which the disease is named.
Two versions of the mothers' symptoms are given. While there are some differences in these, they do have a great deal in common, and can be seen to have been derived from the same source. When these are examined closely, it is found that most of the mothers' symptoms are typical of the common disorders of pregnancy known to Western
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medicine - morning sickness, fluid retention, and so on. Some suggest infections, but these are not identifiable without further investigation.
Apart from offering the possibility of alternative diagnosis (see p. 87), the authors show a certain ambivalence in their approach to the diagnosis of birth saccng. In opposition to the theory of the type of birth saccng affecting a baby being related to the day of conception, the day of birth, and the mother's symptoms when she is three months pregnant, they repeatedly warn the doctor to be quite certain of his diagnosis of one or another kind of birth s a a n g or minor saccng3 in the context of symptoms observed long after
the child is born (see for example pp. 60-62: 72; 73).
These remarks could be interpreted to refer only to a particular group of symptoms within the general description of one of the large collections of symptoms and syndromes defined as a type of birth sa a n g or minor s a a n g . And this is very pertinent, as will be appreciated when we examine the prescriptions for medicine in the next chapters, because treatment tends to be symptomatic.
In contrast to the above, the symbolic representation of birth sa a n g by means of geometrically symmetrical drawings of the appearance of some of the lesions, and mathematically precise numbers of pustules or abscesses is significantly important to the authors, and cannot be overlooked. Once again, there is a lack of consistency from one version to the next, and sometimes the same illustration is used to depict different diseases. The overall impression is that the degree of severity of the symptoms is matched by the degree of elaboration of the accompanying diagram. Conversely, the number of major
pustules seems to be inversely proportional to the severity of the disease. The large number of 'followers' in most cases suggests a
rash or general skin disorder which produces a relatively small number of bigger pustules or abscesses. This pattern has evidently been observed on internal organs also, but the illustrations of
these lesions can only be a symbolic demonstration of what might be the case, rather than a diagnostic aid. Nevertheless, the total
impression of the symbolic representation of birth saang in all its forms very effectively conveys the message that these diseases are not trivial, and should not be ignored.
Yet a third reason for the lack of clarity in KPC is that there are other ways of diagnosing birth saang, based on distinctly different medical theory. We refer particularly to the theory of the elements
expounded in the basic principles of Thai traditional medicine
summarized in the Introduction (seepp.6, ff.). The absence of this theory, except for occasional mention of the elements (see pp. 39, note 5; 47; 61; 74) is glaring. And when we find that - apart from a few short passages inserted, almost out of context, or attached to the end of descriptions of birth saang - most references to this Ayurvedic based theory of the elements are found in Book VI; we conclude that Thai traditional medicine embraces not one, but at least two completely different systems of medical theory.
How does this second, Indian influenced, school of thought interpret children’s diseases?
As far as birth saang is concerned, little is said. KPC II; 107 (see p. 47) gives mucus and internal heat as the cause of khamaoj and blood and mucus as the cause of internal khamao and saang in a child born on Sunday. KPC IV; 192 includes brief descriptions, from the supplementary texts, of the birth saang of the seven days of the week, in each case, giving the element considered to be the cause: Sunday, internal heat; Monday, water; Tuesday, blood; Wednesday, eating the wrong food, and the element water; Thursday, internal heat;
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