Social Science & Medicine 48 (1999) 1833±1850

Disease and immunity in the pre-Spanish Philippines

Linda A. Newson*
Department of Geography, King's College London, Strand, London WC2R 2LS, UK

Abstract

It is generally asserted that Filipino populations did not su€er the same demographic collapse that followed
Spanish conquest in the Americas because they had previously acquired immunity to Old World diseases through
trading contacts with Asia. This assertion is examined by trying to establish which diseases were present in the
islands in pre-Spanish times and whether populations there could have acquired immunity to them. This is done
through an analysis of the evidence for the presence of infections in China and Japan in particular and the existence
of trading contacts with and between the Philippine islands. The likelihood of immunity being acquired is addressed
®rst through a discussion of the physical and human geography of the islands and what is known of the
epidemiology of individual diseases from modern scienti®c research. Second, it reviews evidence from early colonial
documents and Filipino dictionaries for the presence and impact of Old World diseases in the early colonial period.
The study suggests that Filipino populations had not acquired signi®cant immunities to acute infections in pre-
Spanish times, and that their limited demographic impact in the colonial period derived more from the particular
geography of the islands. It suggests that in terms of its disease history, the Philippines had more in common with
the Paci®c islands than mainland Asia, and that the microbiological boundary between the Old World and the New
is better conceived of as a broad zone. # 1999 Elsevier Science Ltd. All rights reserved.

Keywords: Philippines; Old World diseases; Depopulation; Immunity; Epidemic history

Introduction declined by about 80% within a century of recorded

The geographical isolation of many societies was
broken in the ®fteenth century as Europeans began
expanding overseas bringing in their wake demographic
disaster. In the Americas, Australia and parts of
Oceania in particular populations fell to only fractions
of their precontact size (Borah, 1964; Stannard, 1989).
In the Americas and Australia losses have been esti-
mated to have been as high as 90±95% within the ®rst
100±150 years of European contact (Dobyns, 1966;
Butlin, 1983; Denevan, 1992). Similarly in some of the
Paci®c Islands, notably in Hawaii, Tahiti and the
Marquesas, it has been suggested that the population
* Corresponding author. Fax: +44-171-873-2287.
contact (McArthur, 1967; Stannard, 1989; Rullu, 1991;
Crosby, 1992; Kunitz, 1994). These high levels of
depopulation are dependent on high estimates of pre-
contact populations which in many cases have been
hotly debated (Butlin, 1983; Stannard, 1989; Newson,
1993; Denoon, 1997). Furthermore, it is increasingly
recognised that there were considerable geographical
variations in the level of decline within these broad
areas that derived from particular social and environ-
mental conditions and the nature of colonial contact
and rule (for example, McArthur, 1967; Kunitz, 1994;
Rullu, 1991; Newson, 1993). Nevertheless, it is gener-
ally accepted that populations in these regions su€ered
major losses and that a signi®cant factor in their
decline was the introduction of Old World diseases to
they had not previously acquired immunity. In Africa

0277-9536/99/$ - see front matter # 1999 Elsevier Science Ltd. All rights reserved.
PII: S 0 2 7 7 - 9 5 3 6 ( 9 9 ) 0 0 0 9 4 - 5
1834 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
and Asia initial contact with Europeans does not
appear to have precipitated the same demographic dis-
aster among native peoples and in those regions dis-
eases appear to have played a lesser role. This is not to
say that epidemics were absent in the colonial period,
but that population losses from disease were related
not so much to any lack of immunity, though this may
have been a factor in particularly isolated areas, but to
social and environmental changes that encouraged the
spread of already familiar infections (Borah, 1964;
Curtin et al., 1978; Patterson and Hartwig, 1978;
Kunitz, 1994). In Africa and Asia it was the Europeans
who su€ered the greater losses from disease as they
rapidly succumbed to tropical fevers to which they had
not previously been exposed (Curtin, 1961, 1989).
First contact between Filipinos and Europeans
occurred in 1521 when Ferdinand Magellan seeking
access to the spice trade via a western route around
South America made a fateful visit to the island of
Cebu in the Visayas. Subsequently, other Spanish ex-
peditions in 1525, 1528 and 1542 reached the
Philippines, but it was not until 1565 that Miguel
LoÂpez de Legaspi's well planned expedition ®nally
established a permanent Spanish presence in the
islands. Relatively little research has been conducted
on the early colonial demographic history of the
Philippines, but it has been estimated that in 1565 the
population may have been between 1 and 1.25 million
(Phelan, 1959; Corpuz, 1988; De Bevoise, 1995). By
1655 it had fallen to between 500,000 and 600,000,
excluding those outside Spanish control, which rep-
resents a decline of about 50%. However the period
between 1565 and 1655 encompassed that of the
Hispano±Dutch war (1610±1648) over control of the
spice trade in the Moluccas and Sulawesi that gener-
ated exceptional demands for labour to extract timber,
construct and man ships, and for provisions to support
the war e€ort. There is no doubt that these exceptional
demands resulted in elevated mortality rates and were
a signi®cant factor in the demographic decline in parts
of Luzon in the early seventeenth century where aver-
age losses were about 40% (Phelan, 1958, 1959;
Newson, 1998). Without the Hispano±Dutch War
demographic decline within the ®rst century of Spanish
1
Dictionaries of local languages compiled by Spaniards in
the sixteenth and seventeenth centuries, seven of which are
used here, are a useful source of information on infections,
but their use is not without diculties. Clearly, the content of
individual dictionaries was not comprehensive, but re¯ected
the interest of the compiler. As such, the absence of a term
for a particular disease cannot be taken as evidence for its
absence, while the presence of a large number of terms for a
particular infection does not necessarily re¯ect its signi®cance
to local populations.
rule would have been considerably less. On the other
hand, both the pre-Spanish population and the level of
decline in the late sixteenth century may have been
greater than previously supposed, with some parts of
Luzon losing between 38 and 57% of their populations
(Newson, 1998). Nevertheless, the overall level of
decline within the ®rst century of Spanish rule was
generally lower than that experienced in most parts of
Spanish America, and it has even been suggested that
in certain regions, such as the island of Cebu in the
Visayas, the population increased (VanderMeer, 1967).
Southeast Asia is generally considered to have been
part of the Eurasian disease pool with Old World dis-
eases spreading to the islands as trading contacts with
the mainland developed in the Christian era (McNeill,
1976). Hence, the lower level of depopulation in the
Philippines compared to the Americas is often attribu-
ted to its populations having acquired some immunity
to Old World diseases prior to Spanish arrival in the
sixteenth century (Phelan, 1959; Borah, 1964;
Doeppers, 1968; Larkin, 1972; Owen, 1987; Reid,
1988). Although this explanation is popularly accepted,
the issue of whether or not Filipinos had acquired
immunity to those diseases that devastated New World
peoples has not been investigated directly. Rather it is
inferred from the relatively low level of depopulation
in the early colonial period.
This paper attempts to establish which diseases were
present in the Philippines in pre-Spanish times and to
assess whether populations there could have acquired
immunity to the Old World diseases that devastated
other New World populations following European
contact. In so doing it will address the issue of whether
in terms of its disease history the Philippines should
indeed be grouped with other Asian countries or more
appropriately considered with the Americas, Australia
and the Paci®c Islands. It will therefore examine where
the microbiological boundary between the Old World
and the New in the sixteenth century should be drawn,
but will also consider whether the concept of such a
boundary needs revising.
Since there is a lack of local documentary sources
and palaeopathogical studies for the pre-Spanish
Philippines, and indeed the Southeast Asian archipe-
lago in general, the study will rely largely on historical
evidence from neighbouring regions and what is
known of the epidemiology of particular diseases from
modern scienti®c research. Of particular importance
will be historical evidence for the presence of diseases
on the Asian mainland and Japan and the existence of
trading contacts between them and the Southeast
Asian archipelago that might have facilitated their
introduction. Evidence from Filipino dictionaries com-
piled by Spanish friars in the early colonial period will
be used to assess the familiarity of native populations
with di€erent diseases at the time of Spanish arrival1,
 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
while colonial accounts of the impact of Old World
diseases in the sixteenth and seventeenth century will
be used to provide insights on the level of immunity
acquired by Filipino populations in pre-Spanish times.
Before proceeding it is ®rst necessary to have an
understanding of di€erences in the interaction of para-
sites and their hosts and the concept of immunity and
how it may be acquired (Ramenofsky, 1987).
Some key concepts
Di€erences in the demographic impact of diseases
that followed in wake of European contact are seen to
derive largely from di€erences in the level of immunity
to acute infections, particularly those spread by face-
to-face contact. Most acute infections can only become
endemic in large populations, so the size and distri-
bution of populations is critical to any discussion of
levels of immunity that might have been acquired in
pre-European times. However, diseases that could
become established in small populations may have
played an important role in holding back population
growth thereby preventing acute infections from
becoming endemic. This study will therefore consider
evidence not only for the presence of acute infections,
but for a full range of diseases that may have become
endemic in the Philippines prior to Spanish arrival.
Diseases which may can become endemic in small
populations are mainly those which are not dependent
on direct transmission between humans, but which are
often related to hygienic and environmental conditions
or are spread by nonhuman vectors (Fenner, 1970;
Cockburn, 1971; Black, 1975; Black, 1980; Garruto,
1981; McKeown, 1988). Among the former are many
enteric diseases, such as dysentery and typhoid, while
those spread by nonhuman vectors include leishmania-
sis, malaria, ®lariasis and schistosomiasis. The infec-
tions spread by human contact which can become
established in small populations are those where the
pathogen does not kill its hosts or provoke an immune
response that results in the death of the disease organ-
ism. In such circumstances an infection can persist for
a long period and may recur at intervals. Chronic dis-
eases of this kind include tuberculosis, leprosy and tre-
ponemal infections. The only viral diseases spread by
human contact that historically could have become
endemic in small populations are herpes simplex and
chickenpox which can persist in populations of less
than 1000, and even in isolated family units (Fenner,
1970).
Most acute infections, such as measles, rubella and
smallpox, require the presence of a large population
before they can become endemic. These infections are
spread from human to human and are characterised by
short periods of infection that historically resulted in
1835
high mortality. They normally confer lifelong immu-
nity on survivors and are characterised by short
periods of communicability, generally less than two
weeks. As a consequence, they only become endemic
where human populations are of sucient size to gen-
erate enough susceptibles in the form of children to
maintain the disease inde®nitely, hence they are often
termed `crowd infections'. Bartlett (1957) has estimated
that for measles to become endemic in US cities it is
necessary to have a population of between 200,000 and
300,000 that can generate 7000 susceptibles, though
Black (1975) suggests a higher ®gure of 500,000 for
island populations. Smallpox spreads less rapidly than
measles, hence Fenner et al. (1988) have estimated that
a smaller population of between 100,000 and 200,000
is required to sustain it. Below these thresholds and
where the population is dispersed the spread of a dis-
ease is slow and `fade outs' are common (Neel, 1977;
Cli€ and Haggett, 1988). Small communities may
therefore remain relatively disease-free for long
periods, but their lack of exposure to infection leads to
a build up of susceptibles so that when a disease is
reintroduced through contact with a larger population,
it is associated with high mortality that a€ects adults
as well as children.
Since contacts are fewer in small dispersed popu-
lations and there are frequent `fade outs', in a single
epidemic some communities may escape infection. In
modelling measles epidemics in Iceland, Cli€ and
Haggett (1988) calculated that districts with more than
2000 people were generally a€ected, but they main-
tained that below that threshold not all communities
would be infected and that the probability of a com-
munity escaping infection increased with remoteness.
The spatial impact of a subsequent introduction of the
same disease would be signi®cantly a€ected by the irre-
gular pattern of mortality and immunity produced by
the previous epidemic. Within any region of dispersed
population, therefore, there are likely to be consider-
able di€erences between neighbouring communities in
terms of their epidemic histories and their demographic
trajectories (Haggett, 1994).
Some individuals may have innate immunity to a
particular disease that derives from their genetic, bio-
chemical or physiological make-up, but most acquire it
through contact with the infection. At the community
level populations may acquire immunity through con-
stant exposure to an infection, as those who are more
resistant reproduce and those who are not die in child-
hood. Immunity can only be acquired in large popu-
lations that are constantly exposed to diseases either
because they have become endemic or, less likely, in
smaller populations where intense contacts exist with a
distant area where the disease is sustained in endemic
form. Historical experience suggests that at least a cen-
tury of constant exposure is required for a disease to
1836 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
become endemic (Jannetta, 1987; De Bevoise, 1995).
Once acquired, the level of immunity does not remain
constant, however, but may vary over time according
to population size and dynamics (Lilien®eld and
Lilien®eld, 1980).
The Philippine context
An awareness of the particular environmental and
social conditions in the Philippines is crucial to argu-
ments concerning the immunity that might have been
acquired by local populations in pre-Spanish times.
The hot and humid tropical climate would have gener-
ally favoured the propagation of many diseases, es-
pecially water-borne infections, but, as will be
demonstrated in the discussion of individual diseases,
there were di€erences in the physical geography of the
islands that would have resulted in regional and seaso-
nal variations in the incidence of some infections.
The geography of the islands also had a major in¯u-
ence on the spread of disease. The Philippines com-
prise about 7000 islands but only about 500 exceed
one square mile in area and only eleven are over 1000
square miles (De Bevoise, 1995; Sha€er, 1996) (Fig. 1).
In pre-Spanish times many of the islands were unin-
habited, as they are today, and elsewhere settlements
were small and dispersed. As already indicated the
total pre-Spanish population of the Philippines may
have been between only 1 and 1.25 million.
Although the overall population density of the
islands remained low, it was concentrated in narrow
river valleys or on small discontinuous strips of coastal
plain that were often backed by steep mountains. This
meant that communications between communities were
generally by water rather than overland and that con-
tacts with groups in the interior were limited. The
settlement pattern in the lowlands was based on the
barangay which comprised a social group of perhaps
20±100 families linked together by blood ties, marriage
and ritual kinship. Characteristically the barangays
formed small settlements that clustered on the coast or
a river bank where they subsisted primarily on rice
2
This is a highly speculative ®gure. At the beginning of this
century Beyer (1917) (see also Corpuz, 1988) estimated that
about 10% of the Filipino population, mainly located in the
highlands, enjoyed a degree of independence from central
government. There is some debate as to how far this pro-
portion had changed in colonial times. On the one hand num-
bers were boosted by fugitives from Spanish rule, while on
the other they were reduced as populations were brought
under central administration through the e€orts of the mis-
sionary orders and as commercial activities penetrated interior
regions.
and ®sh (Doeppers, 1968; Fox, 1979; Morga, 1971).
Foreign trade, notably with Arabs and the Chinese,
appears to have stimulated the emergence of a few lar-
ger settlements with more highly developed political
structures (Fox, 1979; Hutterer, 1974, 1977), while at
the time of Spanish arrival Muslim missionaries, tra-
ders and settlers from Brunei had recently established
settlements at Pasig and Tondo in Manila Bay
(Doeppers, 1968; Reed, 1978). Nevertheless, even the
most densely settled lowland areas of the Philippines,
such the Central Plain of Luzon, around Manila Bay
and in Laguna de Bay, possessed very few settlements
that exceeded several thousand in population and most
were considerably smaller (Doeppers, 1972).
In the interior mountain regions, where perhaps not
more than 10% of the population resided2, settlements
probably averaged between 150 and 200 persons, but
often the population was dispersed and sometimes
seminomadic. These groups generally practised shifting
cultivation or subsisted by hunting and gathering
(Keesing, 1962; Doeppers, 1968). Some trade took
place between the highlands and lowlands, but often
relations were hostile and highland groups remained
relatively isolated from those in the lowlands
(Doeppers, 1968; Hutterer, 1974).
The small and dispersed character of the Filipino
population in pre-Spanish times undoubtedly limited
the impact of disease. The absence of large permanent
nucleated settlements would have discouraged the
build up of wastes and parasites and hindered the
spread of those diseases dependent on face-to-face con-
tact. Within this context the study will proceed with an
examination of those infections that may have reached
the islands in pre-Spanish times and discuss whether
native populations are likely to have acquired immu-
nity to them.
Infectious diseases found in small populations
It seems likely that many of the infection diseases
that can establish themselves in small populations
would have been present in Southeast Asia, including
the Philippines, from any early date. Indeed McNeill
(1976) has argued that the well-watered environment
of Southeast Asia was particularly favourable for the
spread of malaria, dengue fever and water-borne en-
teric infections, to the extent that they posed a formid-
able obstacle to population expansion on the scale
experienced in China and India. In the context of this
proposition the following discussion will examine the
likely presence of these infections in the Philippines.
Enteric diseases such as dysentery and typhoid fever
emerged with the beginnings of agriculture and were
probably widespread in Asia before the arrival of
Europeans (Gwei-Djen and Needham, 1993). Recorded
 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850 1837

Fig. 1. Philippine regions and main trade routes.

outbreaks of a diarrhoeal disease occurred in Japan in Local Tagalog, Visayan, Iloko and Bikol terms (see
the ninth century (Jannetta, 1993) and diseases of the Fig. 2 for the distribution of these languages) for
gastro-intestinal tract are commonly described in tra- severe and bloody diarrhoea (dagis, palicor, bolos t.
ditional texts from Southeast Asia (Bamber, 1993). (Ruiz, n.d.; San Buenaventura, 1613; Santos, 1703),
1838 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850

Fig. 2. Approximate linguistic areas relating to dictionaries compiled in the early colonial period (modi®ed after Zorc, 1977).

otol v. (SaÂnchez, 1711; Mentrida, 1841), agsica, etdet i.
(LoÂpez, n.d.), yuis, bugris b. (Lisboa, 1865) and for in-
testinal worms (olay, olyabid, bulati, tiva t. (Ruiz, n.d.;
San Buenaventura, 1613; Santos, 1703), bituc v.
SaÂnchez, 1711), alinta, ariet i. (LoÂpez, n.d.), halod,
pitoc b. (Lisboa, 1865) found in dictionaries compiled
in the early colonial period suggest that they were also
common in the Philippines. Nevertheless, compared to
the mainland, their prevalence was probably moder-
ated by the dispersed settlement pattern that would
 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
have limited the contamination of food and water. It
may also have been aided by the Filipino habit of fre-
quent washing, though this may not have been the
case where rivers were used for the multiple purposes
of bathing and washing clothes and utensils (Chirino,
1969; Morga, 1971; Reid, 1988).
According to McNeill (1976) malaria, dengue and
schistosomiasis had become endemic in southern China
by the ®rst two centuries of the Christian era. They are
also likely to have become established in the
Philippines in pre-Spanish times, though their inci-
dence would have been restricted to regions where
non-human vectors necessary for their transmission
were to be found. Plasmodium falciparum and P. vivax
are both found in the islands and the main vector for
the disease, except in Mindoro, is Anopheles minimus
¯avirostris, which is found in the foothills between 240
and 600 m (Russell, 1932; Salazar et al., 1988; De
Bevoise, 1995). The spread of malaria is often posi-
tively correlated with forest clearance and the estab-
lishment of wet rice cultivation (Boomgaard, 1987).
There is archaeological evidence for domesticated rice
from Andarayan in northern Luzon dated 1700 BC
(Snow et al., 1986). However, intensive wet rice culti-
vation does not appear to have spread to Southeast
Asia until the Christian era (Wheatley, 1983; Hall,
1992; Glover and Higham, 1996) and Spanish descrip-
tions of agriculture in the Philippines in the early colo-
nial period suggests that this form of production was
still quite localised (Keesing, 1962; Scott, 1994).
Although it is not clear when malaria became estab-
lished, the limited genetic resistance to the disease
among Filipino populations suggests a relatively recent
origin (Motulsky et al., 1964; Livingstone, 1985). In
many parts of Southeast Asia malarial resistance takes
the form of high frequencies of abnormal haemoglobin
E. In areas where malaria is endemic it has replaced
GP6D de®ciency as the most prevalent form of red cell
defect that confers some resistance to malaria. In the
Philippines, however, this replacement has not yet
occurred. However, the limited genetic resistance in
Filipino populations could re¯ect the lack of coinci-
dence in the distribution of populations and malaria,
the ine€ectiveness of A. ¯avirostris as a transmitter of
malaria, and/or the presence of alternative hosts,
rather than its recent appearance. While it is not poss-
ible to put a date on the appearance of malaria in the
Philippines, the fact that early Spanish expeditions that
attempted to extend colonial control into the interior
mountain regions often succumbed to fevers suggests
that by the sixteenth century it was well established in
the foothills (for example, Maldonado et al., 1577;
Cabchuela et al., 1582; San AgustõÂ n, 1975). Many of
the dictionaries contain terms for several varieties of
mosquito and all have words for fever, the most com-
mon being lagnat t. and hilanat v., and some have sev-
1839
eral (Ruiz, n.d.; LoÂpez, n.d.; San Buenaventura, 1613;
Santos, 1703; SaÂnchez, 1711; Mentrida, 1841; de
Lisboa, 1865). The Tagalog dictionary compiled by
Miguel Ruiz (n.d.) distinguishes six kinds of fever Ð
daily, tertian, quartan, continual, weak and prolonged
and severe and intense. The reference to tertian and
quartan fevers is particularly signi®cant given their as-
sociation with malaria.
Dengue, which is spread by Aedes aegypti, and also
Ae. albopictus and Ae. polynesiensis, has only been
clinically known for 200 years and historically was
probably not distinguished from malaria. It probably
has a long history in the Philippines for by the begin-
ning of the twentieth century it was not considered a
serious infection and, with the exception of some
mountainous areas or isolated islands, the population
had acquired a high level of immunity to the disease
(Siler et al., 1926; Hayes et al., 1986). Today it is most
prevalent in urban areas where water collects in dis-
carded cans and containers creating ideal breeding
grounds for the mosquitoes. The absence of cities and
lower population densities in the past would have cre-
ated less favourable environments for its spread.
Schistosomiasis, which is dependent on the presence
of snail hosts, was probably localised in areas of wet
rice cultivation. Even today it is found only in some
islands, notably Mindoro, Samar, Leyte and northern
Mindanao, and is most prevalent in densely populated
rice-growing districts (Tabangui and Pasco, 1941;
Farley, 1991).
Leprosy was not a major killer, but it appears to
have been an ancient disease in China, Japan and
Korea (Gwei-Djen and Needham, 1993; Farris, 1993;
Magner, 1993). It probably has a long history in the
Philippines and it was clearly present when the
Spanish arrived. As early as 1578 the Franciscans had
established a leprosy hospital at Naga in the Bikol
Peninsula and later another in Manila (Abad, 1964).
There are numerous words for lepra in the early dic-
tionaries, especially the Visayan dictionaries, but this
may re¯ect Spanish concern about the disease or
equally a failure to distinguish it from yaws which was
probably widespread in the islands. For example, in
Matheo SaÂnchez's Visayan dictionary tabagbac is
translated as both lepra and bubas which could refer to
leprosy, yaws or syphilis (SaÂnchez, 1711). Even though
the incidence of leprosy was probably exaggerated,
more detailed de®nitions, such as amomotol which
appears in the Visayan dictionary of Alonso Mentrida
(1841) as ``St. Lazarus's disease where the ends of the
®ngers are eaten away'', clearly suggests its presence in
the island.
Yaws can survive in small isolated populations and
is endemic in most hot, humid tropical climates where
there is poor hygiene and limited clothing is worn
(McNeill, 1976; Garruto, 1981). Yaws can be debilitat-
1840 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
ing, but it is rarely fatal and it can provide some pro-
tection against venereal syphilis. Yaws and syphilis are
closely related and have similar clinical manifestations
which would have made them virtually indistinguish-
able in the early colonial period. Syphilis is generally
considered to have been introduced by the Portuguese
and therefore to have been absent in China, Japan and
Korea prior to the arrival of Europeans (Jannetta,
1993; Leung, 1993; Magner, 1993). In 1582 the inhabi-
tants of Cebu in the Visayas were reported to be
a‚icted with itchy lesions and `bubas'. The same
account also noted that in Panay `bubas' had been
unknown until the disease was introduced from Bohol
by islanders ¯eeing from raiders from the Moluccas
(Loarca, 1582). This suggests that the disease was new
in the Philippines and that it could have been syphilis
acquired through contact with the Portuguese. By the
1590s it was said that an additional hospital was
required in Manila to treat `bubas' with unctions of
mercury and sweating. However, the same account
noted many people were a‚icted by the disease
because the `land' was suitable for its spread (Anon.,
ca. 1591), which is suggestive of yaws rather than
syphilis.
Bubas are de®ned in all the early dictionaries with
di€erent terms being used according to their severity
and where they were located on the body (Ruiz, n.d.;
San Buenaventura, 1613; Santos, 1703; SaÂnchez, 1711;
Mentrida, 1841; LoÂpez, n.d.; Lisboa, 1865). Only the
Domingo de los Santos (1703) Tagalog dictionary
refers to one type of bubas (cati t.) as `mal franceÂs' or
venereal syphilis. It may be signi®cant that his diction-
ary is the latest of the three Tagalog dictionaries con-
sidered here, but it is worth noting that the term cati is
de®ned in an earlier dictionary as lepra (Ruiz, n.d.).
Most likely many of the local names for bubas referred
to yaws and, as in Indonesia, the spread of venereal
syphilis was inhibited by the prior presence of yaws
which provides strong protection from the disease
(Boomgaard, 1987). In the 1660s the Jesuit father,
Francisco Ignacio Alcina, describes the symptoms of a
disease in which tumours developed all over the body,
but especially on the face, hands and joints, like large
nuts or hazelnuts, which if they were not properly trea-
ted could leave dis®guring scars. He describes the dis-
ease as `general' a€ecting children and adults, being
worse among the latter who were so debilitated that
they were often unable to leave the house for several
months (Yepes, 1996). Although he refers to the dis-
ease as buti, which the compilers of the Visayan dic-
tionaries, de®ne as viruelas (smallpox) (SaÂnchez, 1711;
Mentrida, 1841), in the text he clearly distinguishes it
from smallpox, and the symptoms he describes are sug-
gestive of yaws.
The presence of tuberculosis is less certain. The ®rst
description of tuberculosis in China may date back to
2700 BC, but texts from 400 BC clearly describe the
symptoms (Johnston, 1993). Tuberculosis is commonly
associated with poverty, malnutrition and the crowded,
unhygienic living conditions found in cities. There is
little evidence for the disease in the early colonial
period. The early dictionaries give local names for
asthma (hica, habul t., hucab, hubac v.), coughs (obo t.,
ubo v.) colds and catarrh (sipon t., v., b., panateng i.)
(Ruiz, n.d.; San Buenaventura, 1613; Santos, 1703;
SaÂnchez, 1711; Mentrida, 1841; LoÂpez, n.d.; Lisboa,
1865), and, perhaps surprisingly, Father Alcina placed
respiratory infections at the top of his list of diseases
a‚icting Visayans, attributing their prevalence to the
frequent changes of climate (Yepes, 1996). However,
the dictionaries contain no reference to coughs being
associated with blood which might suggest tuberculo-
sis. Nevertheless, tuberculosis can survive in small
populations and in the nineteenth century it was a
major cause of death in the Philippines, where it had
become endemic in many areas and occasionally
erupted as epidemics (Brewer, 1910; De Bevoise, 1995).
At that time its spread was said to be facilitated by the
Filipino customs of spitting and closing houses at
night. While the incidence of tuberculosis is likely to
have increased signi®cantly during the nineteenth cen-
tury when accelerated population growth against a
background of deteriorating economic conditions
boosted rural±urban migration and rapid urban
growth (De Bevoise, 1995), its presence in pre-Spanish
times cannot be ruled out.
Evidence that some of the aforementioned infections
had become endemic in the Philippines is attested by
the early experience of Spaniards in the region. Even
though Spaniards often described the Filipinos as
healthy with people living to an old age (for example,
Loarca, 1582; Ribadeneira, 1970), they also described
some regions and even whole provinces as unhealthy
and they themselves experienced high mortality rates
(Vera, 1587; Anon., 1594; Moronte, 1595). In 1620 the
Provincial of the Franciscans reported that the order
had lost 40 priests in three years (Audiencia, 1620).
Similarly in the seventeenth century the Jesuits
reported that Spaniards who went to the Visayas fell
ill of `achaques y enfermedades' (indisposition and ill-
nesses) such that very few lived to an old age (Alcina,
1660). Among the diseases identi®ed as causing them
to ``take to their beds and carry them o€ to their
graves'' were severe and malignant fevers, dysentery,
beriberi, bubas and St. Lazarus's disease (Fernandez
and Koback, 1984). In addition, it has already been
noted that Spanish expeditions which penetrated the
foothills often fell victim to malaria.
Although it is generally dicult to identify diseases
from the vague descriptions contained in the documen-
tary record, Spaniards appear to have been most at
risk from many of the infections that had become
 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
endemic in the islands, though this could re¯ect in part
the Eurocentric bias of the documentary sources. This
suggests that local populations had already acquired
some immunity to them though in particular cases it
may have been quite limited and localised. Evidence
for a number of chronic infections derives from their
presence in the late colonial period or more recently by
which time environmental and social conditions had
undergone major changes. For example, the extension
of wet rice cultivation during the colonial period is
likely to have encouraged the spread of malaria and
schistosomiasis. It is also known that the incidence of
malaria increased in the nineteenth century with the
colonisation of the foothills where it was endemic,
while its distribution today may re¯ect in part attempts
to control the disease (De Bevoise, 1995). Finally,
population increase, urban growth and malnutrition,
particularly from the nineteenth century, would have
enhanced the spread of other infections, such as tuber-
culosis. Most likely the impact of endemic diseases in
pre-Spanish times was moderated by the low popu-
lation density which reduced the likelihood of unhygie-
nic conditions developing and limited the opportunities
for face-to-face contact. While enteric diseases, dengue
fever and malaria, may have contributed to low levels
of population density in the islands, probably more
signi®cant was the lack of cultural developments in the
region. In pre-Spanish times the Philippines were per-
ipheral to trade between the major markets in China,
India and Arabia that converged on the Straits of
Malacca. The widespread availability of many pro-
ducts found in the Philippines and the dicult naviga-
tional conditions meant that relatively few traders were
attracted to the islands. As a consequence they were
not so profoundly a€ected by cultural developments
that elsewhere in Southeast Asia stimulated social stra-
ti®cation and the emergence of cities (Shigeru, 1988;
Doeppers, 1972).
Acute infections
Even though a number of infections, such as malaria
and schistosomiasis, may have been present in the
Philippines that were absent in the New World in pre-
Columbian times (Way, 1981), di€erences in the role
of diseases in these two regions in the early colonial
period are seen to derive from di€erences in the level
of immunity to acute infections that populations had
acquired in pre-Spanish times. As noted above, immu-
nity to acute infections may be acquired only in large
populations that are able to sustain them in endemic
form or where smaller populations have constant con-
tact with a region where they have become endemic. In
seems unlikely that they had become endemic in most
of Southeast Asia in pre-Spanish times because the
1841
region was sparsely populated. Reid (1988) has esti-
mated that the total population of Southeast Asia in
1600 was only about 22 million. Pockets of dense
population existed in the maritime trading centres and
areas of intensive rice cultivation Ð in the Red River
delta, parts of Upper Burma, central and east Java,
Bali, southern Sulawesi and, he suggests, parts of
Luzon in the Philippines. Nevertheless, even the most
densely settled provinces of Luzon populations failed
to reach the thresholds deemed necessary to sustain
acute infections and that is without taking into
account the distribution of population within those
regions or geographical and social barriers to the
spread of disease. It seems very doubtful, therefore,
that acute infections could have become established in
the Philippines, so that their occurrence in the islands
would have been dependent on reinfection from a
region where they had become endemic.
Archaeological and early colonial sources suggest
there were some contacts between the Philippines and
Thailand and Vietnam (Bellwood and Omar, 1980;
Lim, 1987), but most epidemics probably originated in
China, Japan or India where large populations enabled
many acute infections to become endemic at an early
date (Hopkins, 1983; Fenner et al., 1988). In 1500
China had a population of between 110 and 130
million, India about 100 million, and the population of
Japan in 1600 was about 10 million (Jannetta, 1987;
Fenner et al., 1988; Leung, 1993). Due to the proxi-
mity of China to the Philippines and growing trading
contacts between the two regions in the centuries prior
to Spanish contact, the epidemic history of China is of
particular signi®cance to that of the Philippines, while
Japan, with whom contacts appear to have been
increasing in the sixteenth century, was most likely a
secondary source of infection.
Fortunately, a number of detailed epidemic chronol-
ogies exist for China and Japan for the Christian era
(Dunstan, 1975; McNeill, 1976; Twitchett, 1959;
Farris, 1985; Jannetta, 1987). The ®rst millennium of
the Christian era saw the disease pools of Europe and
Asia merge as contacts between the continents were
established on a regular basis (McNeill, 1976). Acute
infections ®rst arrived overland along the Silk Road,
and later by sea through the ports of Chekiang and
Fukien on the south China coast, from whence they
were later transmitted to Japan and Korea (Twitchett,
1959; Farris, 1985; Leung, 1993). Smallpox ®rst arrived
in China in the fourth century and by the eleventh cen-
tury treatises on smallpox were being written by pae-
diatricians indicating it had become an endemic disease
of childhood (Leung, 1993). In AD 735±737 a major
epidemic of smallpox occurred in Japan that resulted
in 25±35% mortality, but by the thirteenth century the
disease was a‚icting only young children (Hopkins,
1983; Farris, 1985; Jannetta, 1987; Fenner et al., 1988;
1842 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
Leung, 1993). Measles probably arrived in China
about the same time as smallpox (McNeill, 1976), but
since larger populations are required to sustain it, the
disease probably did not become endemic in China
until after smallpox. Jannetta (1987) doubts that it
became established in Japan prior to the arrival of
Europeans. The pattern of mortality associated with
an outbreak of measles in Japan in AD 998 indicates
that by that date at least it had not become endemic.
Although Japan's total population in 1500 clearly
exceeded the threshold necessary for measles to
become endemic, its particular distribution appears to
have militated against the disease becoming estab-
lished. Other acute infections spread by human contact
that by 1500 had a‚icted China, Japan and Korea
included in¯uenza, mumps and chickenpox (Farris,
1993; Magner, 1993). Yet to arrive were probably scar-
let fever, diphtheria and cholera, all of which probably
failed to reach China until the eighteenth or nineteenth
century (Leung, 1993).
Before examining the trading links that existed
between the Philippines and other Asian regions, it is
worth commenting brie¯y on two diseases, plague and
typhus, which were probably established on the Asian
mainland in pre-Spanish times, but not in the
Philippines. The introduction of bubonic plague would
probably have been dependent on the introduction of
the black or brown rat and their ¯eas which act as the
main vectors for the disease. Suitable rats could have
been carried to China by caravans which travelled the
Silk Road or have been introduced by sea from the
south (McNeill, 1976; Twitchett, 1959). There may
have been an early outbreak of plague in the seventh
century, with a serious epidemic occurring in AD 762.
The disease does not appear to have spread to Japan,
perhaps because there was little trade in goods, such as
rice or grain, between China and Japan that would
attract rats (Jannetta, 1987; Farris, 1993). Meanwhile,
epidemics of plague continued to a‚ict China. Indeed
some have argued that the Black Death that devas-
tated Europe in the fourteenth century may have had
its origins in a epidemic in China in 1331 (McNeill,
1976). Lovric (1987) argues that the description of the
symptoms and spread of an epidemic disease contained
in an old Javanese text suggest that plague may have
a‚icted Bali in the eleventh century. However, others
suggest it did not reach Indonesia until 1910 when it
was introduced by rats carried on a cargo ship bring-
ing rice from Burma (Hull, 1987).
In the Philippines there was an active long-distance
bulk trade in rice within the islands which may have
facilitated the spread of rats (Alva, 1570; Scott, 1982,
1994), but provisions that might attract them did not
®gure signi®cantly among the imports from China,
which were dominated by porcelain, metals and textiles
(for example, Alva, 1570; Anon., 1570; Legaspi, 1572;
Pacheco Maldonado, 1572). Nevertheless, Chinese
trading vessels generally contained living quarters for
merchant families, where provisions are likely to have
been kept that could have attracted rodents and
enabled their survival at least over short distances.
Father Alcina's mid-seventeenth century compendium
of animals found in the Visayas lists a number of
rodents, including rats which he likened to those found
in Spain. These rats were described as infesting rice
®elds and local populations reputedly sought protec-
tion from them through special sacri®ces (SaÂnchez,
1603; MartõÂ n-Meras and Higueras, 1975). This was
probably the local Philippine ®eld rat (Rattus minda-
nensis mindanensis Mearns.) which currently infests rice
®elds; the rats which act as vectors for plague are less
common. The black rat is absent from the islands and
the brown rat (Rattus norvegicus norvegicus
Berkenhaut) is found only in the larger islands and
mainly in the ports and towns (Rabor, 1986). The lat-
ter is regarded as an introduced species and while
small numbers may have been present in the main
trading centres in pre-Spanish times, it is doubtful that
bubonic plague had a‚icted the islands. There is no
evidence for epidemics of bubonic plague in the early
colonial documentary record even though increased
trade and urban growth created more favourable con-
ditions for the propagation of rat populations.
The introduction of epidemic typhus, which is
spread by the human body louse, is even more proble-
matic. It is thought to have developed from murine
typhus which is a disease of rats and other rodents.
Typhus is generally regarded as a relatively new disease
that was ®rst identi®ed in Europe in the ®fteenth cen-
tury and was often associated with crowded unsanitary
conditions that prevailed on large scale military cam-
paigns (Harden, 1993). It is particularly prevalent in
cold dry climates that discourage the frequent washing
of clothing. In the Philippines the hot climate, dis-
persed population and the habit of frequent bathing
would have militated against its spread.
Having established that a number of acute infections
were established in China and Japan in pre-Spanish
times, it is now necessary to examine the contacts that
may have existed with those regions that would have
enabled their spread to the Philippines.
Pre-Spanish foreign trade with the Philippines
In the pre-Christian era contacts between Asia and
the Middle East and India were predominantly over-
land and sailing patterns within the South China Sea
favoured coastal mainland routes. Direct contacts
across the South China Sea were infrequent and often
accidental (Wheatley, 1961; Samuels, 1982). Any dis-
eases that may have been introduced to the Southeast
 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
Asian archipelago would have failed to become ende-
mic there because of the low population density
(Fenner, 1987; Fenner et al., 1988). Further outbreaks
would therefore have depended on their reintroduction.
In the ®rst centuries of the Christian era trade within
Southeast Asia was being integrated into a pattern of
trade that extended from the Red Sea to south China
(Wolters, 1967), but it was not until the ®fth century
AD that direct voyages from Indonesia to China were
occurring on a regular basis. These developments were
stimulated by south China's loss of an overland route
through northern China to west Asia and many of the
products obtained from the islands were substitutes for
those they had previously obtained through the latter
route. Particularly interesting was the substitution of
Arabian resins and frankincense by pine resin from
Sumatra (Wolters, 1967). Since Greek times pine resin
had been used as a remedy for ulcers and eruptions
and its added interest may have been stimulated by the
arrival in China of new diseases, notably smallpox.
Once trade became organised on a regular basis and,
as indicated above, China emerged as a new and con-
stant source of infection, the opportunities that existed
for the introduction of diseases greatly expanded. Due
to its large population, sophisticated market and con-
tacts with the rest of the world, China became a major
focus of Southeast Asian trade (Lim, 1987). Foreign
envoys were actively encouraged to visit China taking
with them exotic goods as a form of tribute in recog-
nition of the superior status of the emperor. In return
they received prestigious gifts and titles. The ®rst tri-
bute missions from the Philippines date from the ele-
venth century (Chang, 1934; Scott, 1984, 1989). In
addition, in the twelfth century pirates from the
Visayas were conducting raids on the south China
coast (Clark, 1991). Up to the twelfth century traders
had sailed to China, but subsequently China displayed
a growing interest in the Southeast Asian archipelago
and Chinese traders began to penetrate the main ship-
ping lines of the South China Sea. However, by the
beginning of the fourteenth century the Chinese gov-
ernment had become alarmed at the out¯ow of met-
allic currency and in response imposed import duties
at Chinese ports and prohibited private trading in
gold, silver, copper currency, ironware and slaves
(Chang, 1934; Wheatley, 1961). While Chinese trade
with the Southeast Asian archipelago generally lan-
guished and Muslim traders began penetrating estab-
lished maritime trading routes (Andaya and Ishii,
1992), the Philippines appear to have remained an im-
portant focus of Chinese trade. This is attested by the
large quantities of porcelain from the Yuan and early
Ming periods recovered from archaeological sites
throughout the Philippines (Fox, 1967; Hutterer,
1977).
When the Spanish arrived in the Philippines trade
1843
with China appears to have been dominated foreign
trade, but trade with Malacca through Sulu and
Brunei was also signi®cant, some of it conducted by
traders based in the Philippines (Loarca, ca. 1586;
CortesaÄo, 1944; Wolters, 1967; Scott, 1994) (Fig. 3). It
has been suggested that diseases may have arrived in
the islands through the latter route with populations in
the Southeast Asian archipelago acting as `boosters' in
maintaining chains of infection (De Bevoise, 1995).
The expansion of trade was facilitated by improve-
ments in nautical engineering, which included the
development of the maritime compass and the ocean-
going `junk' (Needham, 1971; Manguin, 1980).
Distances were relatively short and the junks carried
sucient crew and passengers to maintain chains of
infection. Although the time taken undoubtedly varied
between vessels and with the prevailing winds, the
journey from Canton or Amoy in southern China to
the Philippines, a distance of 650±700 miles, could take
as little as six to eight days, though often longer, while
from the islands to Japan it was only seven or eight
days and to Brunei only 10 days (Riquel et al., 1573;
Sande, 1576; CortesaÄo, 1944; Schurz, 1959). Chinese
trading junks could carry several hundred people.
According to Marco Polo, they commonly had 60
cabins for merchants and their families and between 40
and 100 sailors (Needham, 1971). It is signi®cant that
merchants travelled with their families, because chil-
dren could have carried the infections when most
adults coming from regions where diseases were ende-
mic would have been immune. The cramped conditions
on board and the need to store provisions to support
trading families would have also created unhygienic
conditions that encouraged the spread of disease.
In 1572 it was said that 12±15 ships came from
mainland China annually (Pacheco Maldonado, 1572),
but there were probably fewer in pre-Spanish times
because the Chinese were quick to respond to the new
opportunities for trade a€orded by the establishment
of a permanent Spanish presence in the islands. Fewer
Japanese traded in the islands, mainly on the west
coast of Luzon, in Ilocos and Pangasinan. Many of
them were pirates who indulged in trade or raiding as
the opportunities presented themselves (Pacheco
Maldonado, 1572; Loarca, 1582; Vera, 1585; Boxer,
1953). By 1570, when the Spanish explored southern
Luzon 40 Chinese and 20 Japanese had settled on the
Pasig River in Manila Bay (Anon., 1570).
The spread of acute infections within the Philippines
While opportunities existed for the introduction of
acute infections to the Philippines, their spread
through the islands was more problematic. There is
considerable documentary evidence to indicate that
1844 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
Fig. 3. Major trading routes between the Philippines and the rest of Asia on the eve of Spanish contact.
foreign trade in the Philippines focused on a limited
number of ports, notably Manila, Mindoro, Cebu,
Mindanao and Jolo, from which Muslim traders dis-
tributed Chinese goods to other islands in the archipe-
lago and in return collected products which they
traded with the Chinese and in Malacca (for example,
Legaspi, 1567; Lavezaris et al., 1567; Pacheco
Maldonado, 1572; Mirandaola, 1574). Apart from cot-
ton and marine products (coral, pearls and tortoise-
shell), Chinese interest in the Philippines focused on
items extracted from the forests, including beeswax,
betel nuts, civet and civet cats, animal hides and rat-
tans, that were found in interior regions (Wheatley,
1959; Chau Ju-Kua, 1967; Scott, 1984, 1994). Forest
products, particularly deer skins, were also a major
focus of Japanese trade (Chau Ju-Kua, 1967; Morga,
1971; Scott, 1994). It is clear from the porcelain and
other trade items found in interior parts of the islands,
such as among the Igorot, Ifugao and Kalinga of
upland Luzon (Lim, 1987), that the acquisition of for-
est products e€ectively established a network of
trading contacts that extended to remote locations
beyond the limits of kinship ties (Hutterer, 1974,
1977).
While the existence of trading networks enabled the
spread of disease, communications within the islands
were slow and the population dispersed. The barangays
and caracoas used for interisland trade were smaller
and slower than trading junks or Spanish ships
(Andrada, n.d.; Doeppers, 1968; Morga, 1971).
Spanish ships were not renowned for their speed, but
when they were accompanied by native boats they
often had to stop at regular intervals to allow them to
catch up. Such was the experience of Magellan's ¯eet
when it sailed between islands in the Visayas in 1521
(Lessa, 1975). It was also given as the reason why in
1571 it took one month for Miguel LoÂpez de Legaspi's
expeditionary force to transfer the Spanish base in the
Philippines from Panay to Manila (Noone, 1986).
Progress overland was even slower and, since the
population was dispersed and communications between
them, particularly in the interior uplands, were often
limited by the rugged terrain and hostile relations,
many diseases would have died out before they
 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
encountered new susceptibles to infect. This meant
that it was dicult for acute infections to become
endemic and for local populations to acquire immunity
to them. Only in the more populated trading centres
that were regularly visited by foreign traders is it poss-
ible that populations acquired a degree of immunity to
acute infections in pre-Spanish times.
Early Filipino dictionaries indicates a familiarity
with both smallpox (bolotong t., buti v., burtong i.,
poco b.) and measles (tiplas, tipdas t., v., b, darap v.),
though the latter does not appear in Francisco LoÂpez'
Iloko dictionary (Ruiz, n.d.; LoÂpez, n.d.; San
Buenaventura, 1613; Santos, 1703; SaÂnchez, 1711;
Mentrida, 1841; Lisboa, 1865). In the Visayas and
Bikol di€erent types of smallpox were identi®ed.
Honga in Bikol was described as `fatal' (Lisboa, 1865)
and pinarurcan in Visayan was de®ned as `the virulent
kind' (SaÂnchez, 1711). The inclusion of these terms
suggests that certain strains of the diseases at least had
been associated with high mortality and that local
populations had possessed limited immunity to them.
Other acute infections for which words appear in
early Filipino dictionaries are mumps (bayiqui, bicqui
t.) (Ruiz, n.d.; San Buenaventura, 1613) and scarlet
fever. The latter only appears in the Visayan dictionary
of Alonso de Mentrida (1841), which gives panapton
and cagmapula for escarlatina. However, scarlet fever
is generally considered to be a relatively new disease
that probably did not appear in Europe until the six-
teenth or seventeenth centuries (Hardy, 1993). In ad-
dition, today it is not known by local names but as
escarlatina, which suggests that its appearance dated
from the Spanish period. It seems likely that Mentrida
was attempting to describe a disease for which there
was no Spanish term and that he used escarlatina as
the word that most closely described its symptoms.
While early dictionaries provide some evidence for
the limited familiarity of Filipinos with smallpox and
measles, and possibly mumps, in pre-Spanish times,
the existence of only a few lexical borrowing of
Chinese terms for diseases, drugs and medical treat-
ments in Tagalog (Hart, 1969) suggests a relatively lim-
ited acquaintance with acute infections introduced
from China. Furthermore, the pattern of mortality
produced by epidemics of smallpox and measles in the
early colonial period provides added evidence that
levels of immunity acquired by local populations were
limited.
Epidemics in the early colonial Philippines
There appear to have been at least three important
epidemics in the sixteenth century and a number of
more localised outbreaks. Spanish accounts are often
not speci®c about the disease or those a€ected, but a
1845
few suggest that smallpox and measles had not become
endemic. The ®rst acute infection to be identi®ed by
the Spanish was smallpox which in 1574 a‚icted all
the islands. It was described as a `gran enfermedad' (a
great sickness) from which many died (Lavezaris,
1574). The Augustinian father, MartõÂ n de Rada, elabo-
rated that the epidemic had spared ``neither child, nor
youth, nor old person'' (Rada, 1574). The fact that he
did not specify able-bodied adults suggests that the
same disease may have struck the population over a
decade previously. A rather similar pattern of infection
appears to have accompanied a disease introduced in
the 1590s. The Jesuit father, Pedro de Chirino, claimed
that the disease was smallpox, which the locals called
bolotong, and that in the parish of Balayan, in south-
west Luzon, it was ``killing o€ children and old men,
although of greater danger to adults than to the
young'' (Chirino, 1969, pp. 21, 254). The use of the
local name, which also appears in the early diction-
aries, suggests a familiarity with the disease, but the
fact that adult mortality was experienced indicates that
there had been an extended interval since the last out-
break. Only a few years later another disease referred
to only as `peste' caused high mortality in many parts
of the Luzon to the extent that it was feared that the
population would become extinct ``as in Santo
Domingo'' (NuÂnÄez, 1595; Almerique, 1597; GarcõÂ a,
1600; Malumbres, 1918). Although there is insucient
information to identify this disease, clearly the com-
parison with Santo Domingo was intended to draw
attention to the magnitude of its impact and it suggests
that like native populations of the Greater Antilles,
those of the Philippines similarly possessed limited
immunity to at least some newly-introduced diseases.
It is perhaps worth noting that the acute infections
introduced in the early colonial period came not from
the Americas, but from Asia with which trade intensi-
®ed in the early colonial period. The small size of the
crews that manned Spanish galleons, which in the
early colonial period numbered between 60 and 100
men, and the three-month long journey westwards
across the Paci®c Ocean (Schurz, 1959), suggests that
few if any acute infections could have survived the
crossing. Until ships became larger and quicker, the
possibility of diseases being introduced from the New
World remained remote. On the other hand, by the
1580s the number of ships arriving directly from the
mainland had doubled to over 30 (Anon., 1584; Vera,
1587; Ayala, 1588) and by the end of the sixteenth cen-
tury regular trade had been established with China and
8000 Chinese had settled in Manila where they had
opened 400 shops (Schurz, 1959).
In summary, it would appear that in the early colo-
nial epidemics resulted in high mortality, though this
depended in part on the length of time that had
elapsed since the population had been previously
1846 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
infected by the same disease. However, the scale of epi-
demics appears to have been limited by the relatively
small populations and the dispersed settlement pattern
of the islands so that some communities and even
whole regions were able to escape individual epidemics.
During the seventeenth century the opportunities for
the introduction of infections were reduced as trade
with China declined as a result of political upheavals,
population decline and famine, and as Japan pursued
a policy of isolation (Reid, 1993). Epidemics tended to
strike every 20 years as new generations emerged that
lacked immunity (DõÂ az, 1890). Whilst these epidemics
caused high mortality, many communities escaped
infection such that as late as the eighteenth century
there were still many groups in the interior parts of the
Philippines which it was claimed had never experienced
smallpox (Succio, 1707; Scott, 1974). De Bevoise
(1995) suggests that the impact of acute infections in
the Philippines was felt most profoundly, not in the
early colonial period, when the impact of acute infec-
tions was moderated by the size and distribution of the
population, but in the nineteenth century when popu-
lation growth and improved communications greatly
facilitated their spread.
Conclusion
The evidence presented suggests that among the
infections that probably became endemic in pre-
Spanish times were enteric diseases, malaria, dengue,
leprosy, yaws and possibly schistosomiasis and tuber-
culosis. These may have retarded population growth in
the islands, but the cultural isolation of its populations
was probably more signi®cant. The study has also
shown that ample opportunities existed for the intro-
duction of acute infections, notably smallpox and
measles, either direct from China or indirect through
other islands in the Southeast Asian archipelago.
However, the spread of such infections through the
Philippine archipelago was more problematic. Single
epidemics probably caused high mortality, but each is
likely to have a€ected only a small number of islands
and communities before it died out. The inability of
the islands' small populations to sustain acute infec-
tions inde®nitely, coupled with the fact that subsequent
introductions of the same infection would have been
unlikely to have followed the same trajectory, particu-
larly in remote locations, makes it doubtful that
Filipino populations could have acquired high levels of
immunity to acute infections from the Old World in
pre-Spanish times. This is supported by the high mor-
tality rates associated with epidemics in the early colo-
nial period that involved adults as well as children.
However, since the impact of these epidemics was loca-
lised, the overall level of depopulation in the islands
was generally lower than that which accompanied
European contact in the Americas, Australia and some
Paci®c Islands.
While the microbiological boundary between the Old
World and the New in the ®fteenth century is often
drawn between Asia and the Paci®c, this study
suggests that parts of Southeast Asia might be more
appropriately grouped with the Paci®c islands.
However, the cordon sanitaire was weaker closer to
Asia (Denoon, 1997), such that the Philippines were
home to a greater number of endemic diseases than
regions further east and were also visited more fre-
quently by acute infections. However, it was not only
a matter of distance, for as the case of the Philippines
has demonstrated, a region's disease history was sig-
ni®cantly in¯uenced by its geography and the character
and distribution of its populations. Also, the in¯uence
of these factors would have also varied for di€erent
infections. It seems inappropriate, therefore, to con-
ceive of sharp microbiological boundaries between
large regions, and better to imagine broad zones within
which disease histories varied with local environmental,
demographic and cultural circumstances.
Acknowledgements
This study is part of a larger study of the demo-
graphic history of the Philippines. The author would
like to thank the British Academy, the Central
Research Fund of the University of London, the
School of Humanities, King's College London and the
Newberry Library, Chicago for ®nancial support to
undertake this research.
References
Abad, A., 1964. Los franciscanos en Filipinas (1578±1898).
Revista de Indias 24, 411±444.
Alcina, F.I., 1660. Archivum Romanum Societatis Iesu,
Rome, Provincia Philippinarum 12€.1-12 Francisco
Ignacio Alcina 24.6.1660.
Almerique, F., 1597. Archivum Romanum Societatis Iesu,
Rome, Provincia Philippinarum 9 €.313-14 Francisco
Almerique 23.6.1597.
Alva, J., de 1570. Archivo General de Indias, Seville,
Patronato 24±9 Fray Juan de Alva to Crown 20.7.1570.
Andaya, B.W., Ishii, Y., 1992. Religious developments in
Southeast Asia, c. 1500±1800. In: Tarling, N. (Ed.), The
Cambridge History of Southeast Asia, vol. 1. Cambridge
University Press, Cambridge, pp. 508±571.
Andrada, A., de n.d. Archivo General de Patronato 26±6
RelacioÂn de Antonio de Andrada to Crown.
Anon., 1570. Archivo General de Indias, Seville, Patronato
24±17 RelacioÂn de lo sucedioÂ.8.5.1570. Translated in E.H.
 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
Blair, J.A. Robertson (Eds.), The Philippine Islands 1493±
1898, vol. 3, A.H. Clark, Cleveland, 1903, pp. 72±104.
Anon., 1584. Archivo General de Indias, Seville, Patronato
25±16 Valor de los bastimientos 15.6.1584.
Anon., ca. 1591. Archivo General de Indias, Seville,
Audiencia de Filipinas 74 Expediente sobre la cobranza de
los tributos, no date (ca. 1591).
Anon., 1594. Archivo General de Indias, Seville, Audiencia de
Filipinas 59±31 InformacioÂn del hospital de Manila
16.2.1594.
Audiencia, 1620. Archivo General de Indias, Seville,
Audiencia de Filipinas 21±8 Audiencia to Crown 1.8.1620.
Ayala, 1588. Archivo General de Indias, Seville, Audiencia de
Filipinas 18A Licenciado Ayala to Crown 20.6.1588.
Bamber, S., 1993. Diseases of antiquity and the premodern
period in Southeast Asia. In: Kiple, K. (Ed.), The
Cambridge World History of Human Disease. Cambridge
University Press, Cambridge, pp. 425±440.
Bartlett, M.S., 1957. Measles periodicity and community size.
Journal of the Royal Statistical Society, Series A 120, 48±
70.
Bellwood, P., Omar, M., 1980. Trade patterns and political
developments in Brunei and adjacent areas, AD 700±1500.
Brunei Museum Journal 4 (4), 155±179.
Beyer, H.O., 1917. Population of the Philippine Islands in
1916. Philippine Education Co, Manila.
Black, F.L., 1975. Infectious diseases in primitive societies.
Science 187, 515±518.
Black, F.L., 1980. Modern isolated preagricultural popu-
lations as a source of information on prehistoric epidemic
patterns. In: Stanley, N.F., Joske, R.A. (Eds.), Changing
Disease Patterns and Human Behaviour. Academic Press,
New York, pp. 37±54.
Boomgaard, P., 1987. Morbidity and mortality in Java 1820±
1880: changing patterns of disease and death. In: Owen,
N.G. (Ed.), Death and Disease in Southeast Asia:
Explorations in Social, Medical and Demographic History.
Oxford University Press, Oxford, pp. 48±69.
Borah, W., 1964. America as model: the demographic impact
of European expansion on the non-European world. In:
Actas y Memorias, 35th Congreso Internacional de
Americanistas, 3, pp. 386±387.
Boxer, C.R., 1953. South China in the Sixteenth Century.
Hakluyt Society, London.
Brewer, I.W., 1910. Tuberculosis in the Philippines. Philippine
Journal of Science 5, 331±333.
Butlin, N.G., 1983. Our Original Aggression. George Allen
and Unwin, Sydney.
Cabchuela et al., 1582. Archivo General de Indias, Seville,
Audiencia de Filipinas 29±31 AndreÂs Cabchuela, Luis de
Vivanco and Juan Baptista Romana to Crown 20.5.1582.
Chang, T., 1934. Sino-Portuguese Trade from 1514 to 1614: a
Synthesis of Portuguese and Chinese Sources. E.J. Brill
Ltd, Leiden.
Chau Ju-Kua, 1967. Chau Ju-Kua's description of the
Philippines in the thirteenth century: a new translation.
Historical Bulletin 11, 69±72.
Chirino, P. de, 1969. RelacioÂn de las Islas Filipinas. Historical
Conservation Society, Manila.
Clark, H.R., 1991. Community, Trade and Networks:
Southern Fujian Province from the Third to the
1847
Thirteenth Century. Cambridge University Press,
Cambridge.
Cli€, A., Haggett, P., 1988. Atlas of Disease Distributions.
Blackwell, Oxford.
Cockburn, A.T., 1971. Infectious diseases in ancient popu-
lations. Current Anthropology 12, 45±62.
Corpuz, O.D., 1988. In: The Roots of the Filipino Nation,
vol. 1. AKLAHI Foundation, Quezon City.
CortesaÄo, A., 1944. In: The Suma Oriental of Tome Pires, vol
1. Hakluyt Society, London.
Crosby, A.W., 1992. Hawaiian depopulation as a model for
the Amerindian experience. In: Ranger, T., Slack, P.
(Eds.), Epidemics and Ideas: Essays on the Historical
Perception of Pestilence. Cambridge University Press,
Cambridge, pp. 175±202.
Curtin, P.D., 1961. `The white man's grave': image and rea-
lity. Journal of British Studies 1, 94±110.
Curtin, P.D., 1989. Death by Migration: Europe's Encounter
with the Tropical World in the Nineteenth Century.
Cambridge University Press, Cambridge.
Curtin, P.D., Feierman, S., Thompson, L., Vansina, J., 1978.
African History. Longman, Harlow.
De Bevoise, K., 1995. Agents of the Apocalypse: Epidemic
Disease in the Colonial Philippines. Princeton University
Press, Princeton.
Denevan, W.M. (Ed.), 1992. Native Population of the
Americas in 1492. University of Wisconsin Press,
Madison.
Denoon, D., 1997. The Cambridge History of the Paci®c
Islanders. Cambridge, Cambridge University Press.
DõÂ az, C., 1890. Conquistas de las Islas Filipinas. Imp. L.N.
de Gaviria, Valladolid.
Dobyns, H.F., 1966. Estimating aboriginal American popu-
lation: an appraisal of techniques with a new hemispheric
estimate. Current Anthropology 7, 395±416.
Doeppers, D., 1968. Hispanic in¯uences on demographic pat-
terns in the central plain of Luzon, 1565±1780. University
of Manila Journal of East Asiatic Studies 12, 11±96.
Doeppers, D.F., 1972. The development of Philippine cities
before 1900. Journal of Asian Studies 31, 769±792.
Dunstan, H., 1975. The late Ming epidemics: a preliminary
survey. Ch'ing-shih wen-t'i 3 (3), 1±59.
Farley, J., 1991. Bilharzia: a History of Imperial Tropical
Medicine. Cambridge University Press, Cambridge.
Farris, W.W., 1985. Population, Disease and Land in Early
Japan: 645±900. Cambridge University Press, Cambridge.
Farris, W.W., 1993. Diseases of the premodern period in
Japan. In: Kiple, K. (Ed.), The Cambridge World History
of Human Disease. Cambridge University Press,
Cambridge, pp. 376±385.
Fenner, F.L., 1970. The e€ects of changing social organis-
ation on the infectious diseases of man. In: Boyden, S.
(Ed.), The Impact of Civilisation on the Biology of Man.
Australian National University Press, Canberra, pp. 48±
76.
Fenner, F.L., 1987. Smallpox in Southeast Asia. Crossroads:
an Interdisciplinary Journal of Southeast Asian Studies 3
(2-3), 34±48.
Fenner, F., Henderson, D.A., Arita, I., Jezek, Z., Ladnyi,
I.D., 1988. Smallpox and its Eradication. WHO, Geneva.
1848 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
Fernandez, P., Koback, C., 1984. Alcina's historia de las islas
e indios de Bisayas. Philippiniana Sacra 57, 436±517.
Fox, R.B., 1967. The archaeological record of Chinese in¯u-
ences in the Philippines. Philippine Studies 15 (1), 51±62.
Fox, R.B., 1979. The Philippines in prehistoric times. In:
Garcia, M. (Ed.), Readings in Philippine prehistory.
Filipiana Book Guild, Manila, pp. 35±61.
GarcõÂ a, D., 1600. Archivum Romanum Societatis Iesu, Rome,
Provincia Philippinarum 10 €.5±12 Diego Garcõ a 8.6.1600.
Garruto, R.M., 1981. Disease patterns of isolated groups. In:
Rothschild, H. (Ed.), Biocultural Aspects of Disease.
Academic Press, New York, pp. 557±597.
Glover, I.C., Higham, C.F.W., 1996. New evidence for early
rice cultivation in South, Southeast and East Asia. In:
Harris, D.R. (Ed.), The Origins and Spread of Agriculture
and Pastoralism in Eurasia. UCL Press, London, pp. 413±
441.
Gwei-Djen, Lu., Needham, J., 1993. Diseases of antiquity in
China. In: Kiple, K. (Ed.), The Cambridge World History
of Human Disease. Cambridge University Press,
Cambridge, pp. 345±354.
Haggett, P., 1994. Prediction and predictability in geographic
systems. Transactions of the Institute of British
Geographers NS 19, 6±20.
Hall, K.R., 1992. Economic history of Southeast Asia. In:
Tarling, N. (Ed.), The Cambridge History of Southeast
Asia, vol. 1. Cambridge University Press, Cambridge, pp.
183±275.
Harden, V.A., 1993. Typhus, epidemic. In: Kiple, K. (Ed.),
The Cambridge World History of Human Disease.
Cambridge University Press, Cambridge, pp. 1080±1084.
Hardy, A., 1993. Scarlet fever. In: Kiple, K. (Ed.), The
Cambridge World History of Human Disease. Cambridge
University Press, Cambridge, pp. 990±992.
Hart, D.V., 1969. Bisayan Filipino and Malayan humoral
pathologies: folk medicine and ethnohistory in Southeast
Asia. Southeast Asia Program, Data Paper 76. Cornell
University, Ithaca.
Hayes, C., Mamiloto, C., O'Rourke, T., Schultz, G., Basaca-
Seveilla, V., Gonzales, A., Ranoa, C., Cross, J., 1986.
Dengue studies in the Philippines. In: Arbovirus Research
in Australia, Proceedings of the 4th symposium, Brisbane.
CSIRO Tropical Animal Science, pp. 43±44.
Hopkins, D.R., 1983. Princes and Peasants: Smallpox in
History. University of Chicago Press, Chicago.
Hull, T.H., 1987. Plague in Java. In: Owen, N.G. (Ed.),
Death and Disease in Southeast Asia: Explorations in
Social, Medical and Demographic History. Oxford
University Press, Oxford, pp. 210±234.
Hutterer, K., 1974. The evolution of Philippine lowland so-
cieties. Mankind 9, 287±299.
Hutterer, K.L., 1977. Prehistoric trade and the evolution of
Philippine societies: a reconsideration. In: Hutterer, K.
(Ed.), Economic Exchange and Social Interaction in
Southeast Asia: Perspectives from Prehistory, History and
Ethnography. Centre for South and Southeast Asian
Studies, The University of Michigan, Ann Arbor, pp. 177±
196.
Jannetta, A.B., 1987. Epidemics and Mortality in Early
Modern Japan. Princeton University Press, Princeton, NJ.
Jannetta, A.B., 1993. Diseases of the premodern period in
Japan. In: Kiple, K. (Ed.), The Cambridge World History
of Human Disease. Cambridge University Press,
Cambridge, pp. 385±389.
Johnston, W.D., 1993. Tuberculosis. In: Kiple, K. (Ed.), The
Cambridge World History of Human Disease. Cambridge
University Press, Cambridge, pp. 1059±1068.
Keesing, F.M., 1962. The Ethnohistory of Northern Luzon.
Stanford University Press, Stanford.
Kunitz, S.J., 1994. Disease and Social Diversity: the
European Impact on the Health of Non-Europeans.
Oxford University Press, Oxford.
Larkin, J., 1972. Pampangans: Colonial Society in a
Philippine Province. University of California Press,
Berkeley and Los Angeles.
Lavezaris, G., 1574. Archivo General de Indias, Seville,
Audiencia de Filipinas 6 Guido de Lavezaris to Crown
16.7.1574.
Lavezaris, G. et al., 1567. Archivo General de Indias, Seville,
Audiencia de Filipinas 29±3bis Guido de Lavezaris,
AndreÂs Cabchuela and AndreÂs de Mirandaola to Crown
26.7.1567.
Legaspi, M.L., de 1567. Archivo General de Indias, Seville,
Audiencia de Filipinas 6 Miguel LoÂpez de Legaspi to
Crown 23.7.1567. Translated in E.H. Blair, J.A. Robertson
(Eds.), The Philippine Islands 1493±1898, vol. 2, A. H.
Clark, Cleveland, 1903, pp. 234±249.
Legaspi, M.L., 1572. Archivo General de Indias, Seville,
Patronato 24±23 Miguel LoÂpez de Legaspi to Crown
11.8.1572.
Legaspi, M.L., n.d. Archivo General de Indias, Seville,
Patronato 24±38 Miguel LoÂpez de Legaspi, no date.
Translated in E.H. Blair, J.A. Robertson (Eds.), The
Philippine Islands 1493±1898, vol. 3. A. H. Clark,
Cleveland, 1903, pp. 54±61.
Lessa, W.A., 1975. Drake's Island of Thieves: Ethnological
Sleuthing. University of Hawaii Press, Honolulu.
Leung, A.K.C., 1993. Diseases of the premodern period in
China. In: Kiple, K. (Ed.), The Cambridge World History
of Human Disease. Cambridge University Press,
Cambridge, pp. 354±362.
Lilien®eld, A.M., Lilien®eld, D.E., 1980. Foundations of
Epidemiology. Oxford University Press, New York.
Lim, A.R., 1987. The Evidence of Ceramics as an Aid in
Understanding the Pattern of Trade in the Philippines and
Southeast Asia. Asian Studies Monograph 36. Institute of
Asian Studies, Bangkok.
Lisboa, M. de, 1865. Vocabulario de la Lengua Bikol (comp.
1628). Colegio de Santo TomaÂs, Manila.
Livingstone, F.B., 1985. Frequencies of Hemoglobin Variants.
Oxford University Press, New York.
Loarca, M. de, 1582. Relation of the Philippine islands,
Miguel de Loarca, 1586. In: Blair, E.H., Robertson, J.A.
(Eds.), The Philippine Islands 1493±1898, vol. 5. A.H.
Clark, Cleveland, 1903, pp. 34±187.
Loarca, M. de, ca. 1586. Relation of the Philippine islands,
Miguel de Loarca, ca. 1586. In: Blair, E.H., Robertson,
J.A. (Eds.), The Philippine Islands 1493±1898, vol. 34.
A.H. Clark, Cleveland, 1903, pp. 376±391.
LoÂpez, F. (n.d.) Vocabulario de la lengua Iloca (comp. ca.
1627). Ms Marsden Collection M2, King's College
London.
 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
Lovric, B., 1987. Bali: myth, magic and morbidity. In: Owen,
N.G. (Ed.), Death and Disease in Southeast Asia:
Explorations in Social, Medical and Demographic History.
Oxford University Press, Oxford, pp. 117±141.
Magner, L.N., 1993. Diseases of the premodern period in
Korea. In: Kiple, K. (Ed.), The Cambridge World History
of Human Disease. Cambridge University Press,
Cambridge, pp. 393±400.
Maldonado, J. et al., 1577. Archivo General de Indias,
Seville, Audiencia de Filipinas 34 Juan Maldonado,
Joachin MoroÂn, Pedro de Chaves and Francisco ChacoÂn
to Crown 1577.
Malumbres, J., 1918. Historia de Cagayan. Colegio de Santo
TomaÂs, Manila.
Manguin, P.-Y., 1980. The Southeast Asian ship: an historical
approach. Journal of Southeast Asian Studies 11 (2), 266±
276.
MartõÂ n-Meras, M.L., Higueras, M.D., 1975. La Historia de
las Islas e Indios del Padre Alcina. Instituto HistoÂrico de
la Marina, Madrid.
McArthur, N., 1967. Island Populations of the Paci®c.
Australian National University Press, Canberra.
McKeown, T., 1988. The Origins of Human Disease. Basil
Blackwell, Oxford.
McNeill, W.H., 1976. Plagues and Peoples. Oxford University
Press, New York.
Mentrida, A. de, 1841. Diccionario de la Lengua Bisaya,
Hiligueina y Haraya de la Isla de Panay (comp. 1637). D.
Manuela y D. Felis Dayot, Manila.
Mirandaola, A., de 1574. Archivo General de Indias, Seville,
Patronato 24±12 AndreÂs de Mirandaola to Crown
8.1.1574.
Morga, A. de, 1971. In: J.S. Cummins (Ed.), Sucesos de las
Islas Filipinas Hakluyt Society, 2nd Ser, vol. 140.
Cambridge University Press, Cambridge.
Moronte, F., de 1595. Archivo General de Indias, Seville,
Audiencia de Filipinas 59±23 InformacioÂn de. . .Francisco
de Moronte 8.6.1595.
Motulsky, A.G., Stransky, E., Fraser, G.R., 1964. Glucose-6-
phosphate dehydrogenase (G6PD) de®ciency, thalassaemia
and abnormal haemoglobins in the Philippines. Journal of
Medical Genetics 1, 102±106.
Needham, J., 1971. In: Science and Civilization in China, vol.
4: Physics and Physical Engineering. Part III: Civil
Engineering and Nautics. Cambridge University Press,
Cambridge.
Neel, J.V., 1977. Health and disease in unacculturated
Amerindian populations. In: Health and Disease in Tribal
Societies, CIBA Foundation Symposium 49. Elsevier,
Amsterdam, pp. 155±168.
Newson, L.A., 1993. The demographic collapse of native
peoples of the Americas, 1492±1650. Proceedings of the
British Academy 81, 247±288.
Newson, L.A., 1998. Old World diseases in the early colonial
Philippines and Spanish America. In: Doeppers, D.F.,
Xenos, P. (Eds.), Population and History: the
Demographic Origins of the Modern Philippines.
University of Wisconsin Center for Southeast Asian
Studies, Madison and the Atenco de Manila University
Press, Quezou City, pp. 17±36.
Noone, M.J., 1986. In: General History of the Philippines,
1849
Part I, vol. I: The Discovery and Conquest of the
Philippines (1521±1581). Manila Historical Conservation
Society, Manila.
NuÂnÄez, J., 1595. Archivo General de Indias, Seville,
Audiencia de Filipinas 35 Juan NuÂnÄez to Crown
24.6.1595.
Owen, N.G. (Ed.), 1987. Death and Disease in Southeast
Asia: Explorations in Social, Medical and Demographic
History. Oxford University Press, Oxford.
Pacheco Maldonado, J., 1572. Archivo General de Indias,
Seville, Patronato 24±25 Juan Pacheco Maldonado to
Crown 20.4.1572.
Patterson, K.D., Hartwig, G.W., 1978. The disease factor: an
overview. In: Hartwig, G.W., Patterson, K.D. (Eds.),
Disease in African History: an Introductory Survey and
Case Studies. Duke University Press, Durham, NC, pp. 3±
24.
Phelan, J.L., 1958. Free versus compulsory labor: Mexico and
the Philippines 1540±1648. Comparative Studies in Society
and History 1, 189±201.
Phelan, J.L., 1959. The Hispanization of the Philippines:
Spanish Aims and Filipino Responses 1565±1700.
University of Wisconsin, Madison.
Rabor, D.S., 1986. In: Guide to the Philippine Flora and
Fauna, vol. 11: Birds and Mammals. Natural Resources
Management Center, University of the Philippines and
the.
Rada, M., de 1574. Archivo General de Indias, Seville,
Audiencia de Filipinas 84±4 MartõÂ n de Rada to Crown
30.6.1574.
Ramenofsky, A.F., 1987. Vectors of Death. University of
New Mexico, Albuqerque.
Reed, R.R, 1978. Colonial Manila: the context of Hispanic
urbanism and process of morphogenesis. University of
California Publications in Geography 22. University of
California Press, Berkeley and Los Angeles.
Reid, A., 1988. In: Southeast Asia in the Age of Commerce
1450±1680, vol. I: The Lands Below the Winds. Yale
University Press, New Haven and London.
Reid, A., 1993. In: Southeast Asia in the Age of Commerce
1450±1680, vol. II: Expansion and Crisis. Yale University
Press, New Haven and London.
Ribadeneira, M. de, 1970. Historia del archipelago y otros
reynos. Historical Conservation Society, Manila.
Riquel, H. et al., 1573. Las nuevas quescriven de las yslas del
poniente, Hernando Hernando Riquel and others to
Crown. Translated in E.H. Blair, J.A. Robertson (Eds.),
The Philippine Islands 1493±1898, vol. 3. A.H. Clark,
Cleveland, 1903, pp. 230±49.
Ruiz, M., n.d. Bocabulario Tagalo (comp. 1580?). Ms
Marsden Collection M2/17, King's College London.
Rullu, J., 1991. Population of the French overseas territories
in the Paci®c, past, present and projected. The Journal of
Paci®c History 26 (2), 169±186.
Russell, P.F., 1932. Malaria: an Account of its Cause, Cure
and Prevention. Manila, Bureau of Printing.
Salazar, N.P., Miranda, M.E.G., Santos, M.N., Llagas, L.A.
de las, 1988. The malaria situation in the Philippines with
special reference to mosquito vectors. Southeast Asian
Journal of Tropical Medicine and Public Health 19 (4),
709±712.
1850 L.A. Newson / Social Science & Medicine 48 (1999) 1833±1850
Samuels, M.S., 1982. Contest for the South China Sea.
Methuen, London.
San AgustõÂ n, G. de, 1975. Conquista de las Islas Filipinas.
Consejo de Investigaciones Superiores, Madrid.
San Buenaventura, S.P. de, 1613. Vocabulario de Lengua
Tagala. Thomas Pinpin and Domingo Loag Tagalogs,
Pila.
SaÂnchez, M., 1603. Archivum Romanum Societatis Iesu,
Rome, Provincia Philippinarum 10 €. 104±107. Mateo
SaÂnchez 12.4.1603.
SaÂnchez, M., 1711. Vocabulario de la Lengua Bisaya (comp.
1617). , Manila.
Sande, F., de 1576. Archivo General de Indias, Seville,
Audiencia de Filipinas 6 Francisco de Sande to Crown
8.6.1576. Translated in E.H. Blair, J.A. Robertson (Eds.),
The Philippine Islands 1493±1898, vol. 4. A.H. Clark,
Cleveland, 1903, pp. 21±97.
Santos, D. de los, 1703. Vocabulario de la Lengua Tagala. ,
Manila.
Schurz, W.L., 1959. The Manila Galleon. E.P. Dutton and
Co, New York.
Scott, W.H., 1974. The Discovery of the Igorots: Spanish
Contacts with the Pagans of Northern Luzon. New Day
Publishers, Quezon City.
Scott, W.H., 1982. Cracks in the Parchment Curtain and
Other Essays in Philippine History. New Day Publishers,
Quezon City.
Scott, W.H., 1984. Prehistoric Source Materials for the Study
of Philippine History. New Day Publishers, Quezon City.
Scott, W.H., 1989. Filipinos in China before 1500. De la Salle
University, Manila.
Scott, W.H., 1994. Barangay. Ateneo de Manila University
Press, Quezon City.
Sha€er, L.N., 1996. Maritime Southeast Asia to 1500. M.E.
Sharpe, Armonk NY.
Shigeru, I., 1988. Emergence of cities in maritime Southeast
Asia from the second century BC to the seventeenth cen-
tury. East Asian Cultural Studies 27, 1±11.
Siler, J.F., Hall, M.W., Parker Hitchens, A., 1926. Dengue:
its history, epidemiology, mechanism of transmission,
etiology, clinical manifestations, immunity and prevention.
Philippine Journal of Science 29, 1±304.
Snow, B.E., Shutler, R., Nelson, D.E., Vogel, J.S., Southon,
J.R., 1986. Evidence for early rice cultivation the
Philippines. Philippine Quarterly of Culture and Society
14, 3±11.
Stannard, D.E., 1989. Before the Horror: the Population of
Hawai'i on the Eve of Western Contact. University of
Hawaii, Honolulu.
Succio, A., 1707. Archivum Romanum Societatis Iesu, Rome,
Provincia Philippinarum 8 €. 74±133 Carta annua by
Antonio Succio 25.1.1707.
Tabangui, M.A., Pasco, A.M., 1941. Studies on the geo-
graphical distribution, incidence and control of
Schistosomiasis japonica in the Philippines. Philippine
Journal of Science 74, 301±329.
Twitchett, D., 1959. Population and pestilence in T'ang
China. In: Bauer, W. (Ed.), Studia Sino-Mongolica:
Festschrift fuÈr Herbert Franke. Steiner, Wiesbaden, pp.
35±69.
VanderMeer, C., 1967. Population patterns on the island of
Cebu, the Philippines: 1500 to 1900. Annals of the
Association of American Geographers 57, 315±337.
Vera, S., de 1585. Archivo General de Indias, Seville,
Patronato 25±2 Santiago de Vera to Crown 20.6.1585.
Vera, S., de 1587. Archivo General de Indias, Seville,
Patronato 25±36 Santiago de Vera to Crown 26.6.1587.
Way, A.B., 1981. Diseases of Latin America. In: Rothschild,
H.R. (Ed.), Biocultural Aspects of Disease. Academic
Press, New York, pp. 253±291.
Wheatley, P., 1959. Geographical notes on some commodities
involved in Sung maritime trade. Journal of the Malay
Branch of the Royal Asiatic Society 32 (2), 5±140.
Wheatley, P., 1961. The Golden Khersonese: Studies in
the Historical Geography of the Malay Peninsula
before AD 1500. University of Malaya Press, Kuala
Lumpur.
Wheatley, P., 1983. Nagara and Commandery: Origins of
Southeast Asian Urbanism. University of Chicago Press,
Chicago.
Wolters, O.W., 1967. Early Indonesian Commerce. Ithaca,
Cornell University Press.
Yepes, V., 1996. Una EtnografõÂ a de los Indios Bisayas del
Siglo XVII. Consejo Superior de Investigaciones
CientõÂ ®cas, Madrid.
Zorc, D.P., 1977. The Bisayan Dialects of the Philippines:
Subgrouping and Reconstruction. Canberra, Australian
National University.