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A primary focus of this thesis is to explore the existence of hot-cold beliefs among South Asian communities in the UK and the relation of these beliefs to thermal care ideologies and practices. This section describes humoral beliefs that are still practiced in some parts of South Asia and that also continue to influence South Asian cultural groups living in the UK. Humoral beliefs in South Asian countries are mainly influenced by Ayurvedic (Zimmerman 2008) and Unani medical systems, which have ancient Greek and Arabic roots (Winch and colleagues 2005), and Siddha medicine, which has Tamil-Dravadian (Southern Indian) roots (Walter 2005; Winch and colleagues 2005). Ayurvedic medicine uses a concept of aiming to maintain conditions in the body in an ‘intermediate zone’

and therefore the concept of balance is extremely important. By remaining in the intermediate zone this ensures no one can be exposed to any of the extremes in

14 order to maintain health. Of the three humors (rather than four as in humoral beliefs with Greek origins), the elements that balance the body, in Ayurvedic medicine (wind, bile and phlegm), wind is the most important because it can carry the other two humors that are also disease causing (Zimmerman 2008).

However, Ayurvedic medicine is only one medical belief system in South Asia. There are other similar beliefs in South Asian cultures that classify people into hot and cold body states (Nichter 1987; Pool 1987), where people with a ‘hot constitution’ are said to be prone to ‘hot’ diseases such as skin rashes and

diarrhoea. By contrast, people with a ‘cold constitution’ are said to be vulnerable to the more internal ‘cold’ diseases such as respiratory infections and joint pain. Thus, they aim to manage their diet and thermal care appropriately to avoid allowing their body states to reach either extreme: According to Zimmerman (2008), “medicine [Ayurvedic] is the art of establishing harmonious yoga or samyoga ‘junctions’ or

‘articulations’ between man and his environment through the prescription of appropriate diets and regimens” (Zimmerman 2008). In some cases, such as with Ayurvedic medicine in South Asia, humoral-based medical systems and

practitioners are so popular that ‘Ayurvedic tourism’ exists, where people from outside South Asia come from around the world to study it or receive treatment (Zimmerman 2008). This indicates that humoral beliefs are not something of the past, and continue to flourish within South Asian culture.

More evidence regarding a continued adherence to humoral beliefs in Pakistan is provided in Nizami and Bhutta’s (1999) study. They found that more than 70% of new mothers could classify food as either cold or hot, although the ability to classify all foods into hot and cold was uncommon. Foods classified as hot or cold in Nizami and Bhutta’s study are listed in appendix 1. Foods that were thought to be very hot were egg; beef; chicken; mutton; liver; aubergine and mango. Foods thought to be very cold were rice; oranges; yoghurt; ice cream;

carrots; bananas and cucumber.

More evidence that humoral beliefs have influenced the older South Asian generation, who have influence over thermal care of newborns at present, is given

15 in Nichter’s (1987) example of a Sri Lankan mother. In this case, the mother persuades her son, who was thought to have a cold constitution, not to leave home to get a job in another town because he would become too vulnerable to cold illnesses, and so the son stayed. This shows how much importance is given to protecting individuals in this culture from imbalance. The mother may have been using his perceived vulnerability to cold to keep her son at home, but her reasoning was based on a plausible explanation of risk of disease in her culture.

Whilst some individuals are thought to have cold or hot constitutions in South Asian cultures, there are also particular phases over the life course of all individuals that put people at risk of cold (Surinder and Kanti 1986; Gardener 1997). Individuals with particular vulnerability to illness because of their cold state include newborns, mothers who have recently given birth, the elderly and the infirm. The cold state of the newborn puts its survival at risk in an environment of high infant mortality. Therefore newborns are taken out as little as possible for the first few months so they are not exposed to people and illnesses (Maharaj 2007). At the same time this mother who has just given birth is also considered to be in a highly dangerous cold state. This vulnerability to illness one of the explanations for maternal mortality, which is high in all South Asian countries, justifying the concern over the mother’s survival.

Winch and colleagues (2005) investigated local knowledge and practices relating to newborns in the Sylhet Region of Bangladesh. The authors examined perceived threats to the infant’s well-being and how the families sought to protect newborn infants from cold using data from a household survey of 6050 women who had recently given birth. They found that newborns in this area were considered to be extremely vulnerable to cold air entering their bodies, contact with a cold substance or cold being passed on to the infant through the mother ingesting a cold category food. Cold was believed to be a malevolent force that was responsible for infant deaths, and was therefore considered extremely dangerous. In contrast to the fatalism reported in other communities with high infant mortality such as in Brazil (Scheper-Hughes 1992), these Bangladeshi mothers were found to actively protect their infants from perceived threats, such as from cold, in a way

16 that needed few resources even for the poorest families. This fatalism has been disputed in other areas of high infant mortality (Nations and Rebhun 1988). Whilst protecting infants from cold, and the illnesses the cold are thought to bring may be disputed by medical professionals, these Bangladeshi mothers cannot be accused of resigning themselves to the inevitability of infant death.

In Pakistan Nizami and Bhutta (1999) conducted a questionnaire survey with doctors and their patients in which 10% of physicians said they believed in hot-cold theory and gave dietary advice based on this despite their understanding that it did not have a scientific basis. It is possible that even more of these doctors held hot-cold beliefs but because of their professional status some may have been hesitant to express them, depending on whom they were addressing, or to admit they provided advice based on non-scientific principles. It is anticipated that physicians everywhere are influenced by their own culture, and they recommend non-scientific remedies where scientific medicine cannot always help. Winch and colleagues (2005) found that amulets, bracelets believed to ward off evil spirits and illness, were sometimes given by doctors to infants and their mothers in

Bangladesh where extra protection was considered necessary (Winch and colleagues 2005). The use of amulets to protect from the “evil eye” and other malevolent forces is as widespread a global phenomenon as humoral beliefs. Whilst adherence to humoral beliefs differs among groups and individuals in South Asia, and also among South Asian groups in the UK, it is important to understand that these beliefs may to a greater or lesser extent still influence their understanding of the aetiology of disease. Although no research has been conducted on the thermal care beliefs of South Asians living in the UK, humoral beliefs regarding hot and cold foods were documented by Griffiths and colleagues (2001) in a comparison of South Asian and white British hospital admissions for asthma. They found that

“some South Asians used traditional medicines or dietary changes consistent with Islamic or Ayurvedic humoral systems, particularly hot food spices such as ginger or turmeric, reflecting a view that cold foods were a cause of asthma” (Griffiths and colleagues 2001:4). Roseanna Pollen’s ethnography of the Bengali community in Bethnal Green, London did not reveal any humoral beliefs but did find that magico-religious beliefs, such as a belief in the evil eye, were common. However,

17 identifying who held these beliefs and to what degree was not easily discernable (Pollen 2002). This difficulty in defining the beliefs of South Asian mothers in the UK exists because of the plurality of health beliefs and because the manner in which people explain diseases can vary depending on the context in which they are living. In the UK, South Asian communities are not stuck between two cultures but are able to draw on more than one belief system in order to make sense of illnesses that threaten or afflict their infants (Reed 2003).

2.2.3 Infant thermal care beliefs of Northern European cultures -