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Several recent studies have argued that the Siamese government's early interest in public health was motivated by ideas of modernization. This article examines the motivations of key figures in policy making, as well as the roles of public opinion and international pressure. Although a Thai term for "public health" was coined in 1918, government was motivated more by traditional ideas of charity than modern ideas of state responsibility. Prior to 1932, the state's provision of medical services was very limited, and people relied more on private hosiptals and pharmacies.

Ayutthaya rose as a maritime power with involvement down the peninsula and in the China trade. Early Ayutthaya resembled coastal polities of the archipelago more than hinterland states of the mainland. Over the fifteenth and sixteenth centuries, Ayutthaya changed by absorbing people, political structures, and cultural practice from the north.