Health received considerable attention
in the ancient and medieval period. The Sinhala kings took an
interest in the matter. Some of them such as King Buddhadasa
(340-368 AD) practised medicine. Buddhadasa set up hospitals in
rural areas, appointed physicians for each group of ten
villages, and gave each physician the produce of ten fields as
livelihood. Between the period 406 AD to 954 AD, hospitals were
also built by Mahanama, Sena 1, Sena 11 and Kassapa V. Mahinda
IV (954-972) provided all the hospitals in the island with beds
Parakramabahu I (1153-1186) who knew
something about medicine sent persons qualified in the art of
healing and well versed in the medical textbooks out to villages
and markets to practise medicine. He "recognised the merits in
all of them and made them day and night practise the art in the
best manner". Parakrama bahu used to visit hospitals on certain
days to comfort the sick and to encourage the cleverer
physicians with rewards. He assigned an attendant to each
patient in hospital.
Sri Lanka evolved its own system of
medicine, known as desiya chikitsa or sinhala vedakam.
This was in existence before the arrival of ayurveda. Skills
were handed down from generation to generation, usually within
the family. Books on indigenous medicine were written in
Sinhalese, Pali and Sanstait, in the form of kavi. Some
were written by Buddhist monks. The Saratthappakasini was a 5th
century text. Yogamavaya and Prayoga Ratnavaliya
belong to the 13th century. Medical ideas from other countries
would also have been absorbed. Lakshman Devasena looked at local
acupuncture and concluded that the Chinese art of acupuncture
was probably known in ancient Sri Lanka. There was also
indigenous veterinary medicine. King Buddhadasa is said to have
appointed veterinarians to treat horses and elephants.
Saddharmalankaraya talks of using the juice of a creeper to
treat a dog for itch.
The vedamaththaya or medical
practitioner was one of the earliest professionals in our
society. Two inscriptions in Puttalam and Hambantota districts
datable to between third and first century BC refer to veda.
The term was used to denote physicians, surgeons, and
veterinarians. Physicians were highly regarded. Around the time
of Dappula IV (923-934), immunities greater than those given to
the granted to one particular physician. In an inscription dated
to the Anuradhapura period, the physicians were referred to as
‘their lordships’. In the medieval period, there was a post of
Chief Physician. He was a member of the king’s council and an
officer of state.
Medical instructions were respected-
An inscription of Mahinda IV says that monks when ill should be
given special food recommended by a physician. Physicians
participated in inquiries against hospital employees.
Saddharmaratnavali and Puiavali, written in the 13th
century, said that the physicians were very secretive about
their medicines. They prepared the oils themselves and did not
give out the recipes to others. Also that the physician had to
be paid for his services and his travelling expenses.
Saddharmalankaraya 13th century
non-medical work refers to 88 diseases, 99 illnesses and 203
dangers. Dysentery, eye disease, elephantiasis abscess, leprosy,
jaundice, indigestion, plague, headache, sores, fever, coughs
and tumours were in this list. Treatment included decoctions,
gruels containing herbs such as polpala and gotukola
oils for internal and external use, and pastes for external
application made of medicinal herbs. There was the ‘kalkaya’
a medicinal paste to be eaten and the ‘nasnaya’ to be
inhaled. Vahni (liquorice) asafoetida, dried ginger, pepper,
ghee, honey, sugarcane Jaggery, cumin and pepper are some of the
items used as medicine, during this period.
There was considerable emphasis on
medicinal herbs. Aggabodhi VII (766-772 AD) studied the
medicinal plants in the island to find out whether they were
wholesome or harmful for the sick. The public would also have
known something about these plants because in the nineteenth
century, the British stated that the Sinhalese had a
considerable knowledge of their indigenous plants. Even an
illiterate person knew the names and properties of the smallest
plant in the vicinity they said, Unlike today, the ancient
Sinhalese would have known not to yank out a plant by its roots
and destroy it.
Certain home remedies are mentioned in
the medieval literature. ‘Kehel saluwa’ a shawl made of
plantain fibre was recommended for consumptive patients. -
Arecanut juice mixed with water was used as an emetic. A paste
made from nelli was used for washing hair. Oily substances or
fat were considered bad for fever, urinary disease and
phlegmatic conditions. Basic hygiene was not forgotten Two
inscriptions date to Mabinda IV and Pmkrmabahu I refer to
cleaning of teeth. Twigs of dahati bombu, kohomba
and palu were used. These twigs provided thick firm
bristles with soft rounded edges. In addition, kohomba
has antiseptic properties.
In a commentary translated in 5 AD by
Buddhagosa from a Sinhala text, there is reference to five types
of fomentation. Steam and hot water therapy was administered in
the Jantaghara at Mihintale hospital. Immersion therapy was
carried out for skin disease, rheumatism, and fever. Medicinal
herbs, milk ghee, oils and winegar were used ‘Beheth oruwas’
for immersion have been found at Anuradhapura, Mihintale,
Mcdirigiriya, Dighavapi, and Polonnaruwa. The one at
Polorautruwa is the beg preserved. They are dated to about 9 AD.
They have been carved out of a single rectangular stone in such
a that once the patient got in, very little medicinal fluid was
needed to immerse him. Uragoda speculates that in ancient times,
some of the household probably had their own private medicinal
Surgery was known- Surgical
instruments such as scissors, knives and a hooked copper
instrument probably used for incising abscesses were found at
Alahana pirivena in Polonnaruwa. This did not disappear. There
are references to various Surgical instruments for opening
boils, abscesses, tumours, for blood letting, catching eyelids,
and examination of fistulas in the medical manuscripts of the
Kandyan period. A manuscript titled Vidurn sastraya written in
Sinhala kavi dealing with surgical operations was found by the
Historical Manuscripts Commission 1951 (SP 19 of 1951.p 50.)
Gynaccology and obstetric skills were similarly well developed.
There were remedies for female sterility. Abortions were carried
out. Saddharmalankaraya mentions the extraction of a dead
foetus, piece by piece from the womb with surgical instruments.
Some of the ancient knowledge may have
survived into the modem age. Bone setting techniques were in use
in the Kandyan period. Fractures were set and pattuva
applied using herbs. British writers subsequently described.
These bone-setting techniques. The British also said that the
Sinhalese excelled as oculists. Around 1843, a vedamaththaya
had used herbs to give back sight to a child, but did not
divulge the herbs used. E.L. Koch writing in 1871 stated that
the Sinhalese had their own eye instruments, which though
"faulty and defective" when compared to European ones, have even
temporarily saved the sight of hundreds of people."
In 1928, it was argued that the
hospitals originated in Asia. Sri Lanka is mentioned. The idea
was thereafter passed on to Syria, Persia, Egypt and the rest of
western Europ Mahavamsa refers to hospitals, dispensaries and
‘medical halls’, The medical halls by were clearly hospitals. In
the case of Kassapa IV (898-914) who ‘built houses where
medicine was to be had in different parts of the town, it is not
clear whether they were pharmacies or out patient centres. A
medical hall has been found near Thuparaina dagoba. A
dispensary is mentioned in the Kiribathvehera
inscription. It said that a person who has committed an offence,
could not be arrested while inside the dispensary. It is not
clear why, Ariyapala stated that that the country was well
served with hospitals and dispensaries by the medieval period.
Medieval literature also indicated the existence of a system of
A range of medical institutions dating
from the fourth century have been found in Sri Lanka Outdoor
treatment was provided in the hospitals as well as at
establishments known as behetage. There was a behetge
datable to the late Anuradhapura period at Arankele. Large
grinding stones, pestles, and nearly sixty furnaces or kilns in
situ suggest that this was a place where medicine were prepared
and dispensed to a large number of outdoor patients and perhaps
to dispensaries. The grinders were wasted in the middle
suggesting their use for a long time. Medicine grinders were
also found at Mihintale and. Polonnaruwa hospitals. These
consisted of two circular stones between which the herbs were
crushed when the upper one was rotated over the lower half.
There were various types of hospitals.
There were royal hospitals catering to the public. These were
maintained by the state. There are references to tenants and
cultivators, therefore we could perhaps infer that some sort of
tenure system was used for this. Kassapa V (914-923) built a
hospital and assigned to it villages.’The inscription attributed
to Udaya 11 (885-896), refers to a land granted to the
Medirigiriya hospital. This land was far away from the hospital.
Kassapa IV built hospitals in
Anuradhapura and Polonnaruwa for combating ‘upasagga’
which was probably an epidemic disease. Institutions for
cripples were build by Buddhadasa, Dhatusena, Upatissa. II, and
Udaya I. Buddhadasa and Upatissa built hospitals for the blind.
In the time of Pandukabhaya (394-307 BC) there was a
convalescent home at Anuradhapura. Maternity hospitals were set
up by Upatissa I (365-406) and Kasyapa IV. There are tenth
century references to public maternity homes. Maternity homes
were established in Europe much later. Private individuals also
funded and maintained hospitals.
There were monastic hospitals situated
within the grounds of monasteries. These were primarily for sick
monks, but the Medirigiriya inscription of Kasyapa V (914-923)
indicates that the public was also treated at those hospitals.
Remains of monastic hospitals have been found in Anuradhapura,
(at Thuparama, and Abhayagiri) Mihintale, Medirigiriya,
Dighavapi, and Dombegoda near Maligavila. These are dated to
Anuradhapura period. Those of the Alahana a Pirivena
complex at Polonnaruwa are dated to the 12th century.
The monastic hospitals were located in
accessible places and designed to allow ventilation. Walls were
erected to isolate the place. They each had a central courtyard
with cells around it and an adjoining outer courtyard with rooms
for dining, bathing and the preparation of medicines. The rooms
opened into a connecting veranda, and they all faced the central
courtyard in the middle of which was the shrine room . At
Alahana hospital the rooms were of varying sizes and each of
them seems to have accommodated a number of inmates. The
immersion room at Mihintale could be entered from within and
without the hospital.
There are remains of several toilet
complexes in the monasteries. Each complex consisted essentially
of a urinal stone and a soakage pit. A beautifully carved urinal
stone, with a drain leading to a terra cotta coakapte pit behind
it was discovered in Galabedde in the eastern province. At
Alahana, there is a toilet complex in which one room was used
for bathing and the other as a toilet. Two soakage pits, built
of bricks were found behind each of these tow rooms. In some
instances drainage water, instead of running into a pit was led
into an earthenware pot or a series of pots placed one above the
other, behind the urinal stone. The pot below was larger than
the one above, and there was a hole in the bottom of each pot.
These were filled with charcoal, ash or sand to ensure graded
There was a distinction between
hospital staff and those entrusted with the management of the
hospital. Management was done by an office with its own
employees. There were different categories of staff, such as
physicians, and dispensers. There were midwives too. Hospital
staff were not permitted to accept gifts or to help themselves
to hospital property. Everyone, including the physicians and
superintendents were liable to dismissal. There were regular
inspections of hospitals by supervisory staff. Merrymaking, with
its attendant noise had to take place away from the hospitals.
The ancient Sinhalese knew about the
development of the human embryo and the significance of the
umbilical cord The Saratthappakasini a 5th century text
from Sri Lanka describes the development of the embryo week by
week, and says that it starts as a small ‘drop of oil’ attached
to a thread, and later acquires protrusion which denote head and
four limbs, and later hair and nails begin to appear. The foetus
is nourished by the navel of the foetus being connected to the
mothers abdomen by a tube ‘which is as hollow as the stem of a
blue lotus’ Through this nutrients flow into the embryo. The
time sequences given for the development of the embryo matches,
the modem view, Europe found out all this only in 1554. There is
no reference to dissection in the Sri Lanka text, but it seems
unlikely that they could have found out all this without
observation. They were similarly well informed as to malaria. In
1905, the vedaralas had told the British who were
inquiring into an epidemic at Mutwal, that according to ancient
texts, the chief causes of malaria were impure water and
mosquitoes. In Europe, Ross had found the link between the
mosquito and malaria in1898. ( Journal Ceylon branch of BMA,
vol. 2 1905 p 9-10)In the twentieth century, desiya chikitsa
was practised by medical lineages or veda paramparawa who
held on to secret family recipes, passing them down the
generations. Horivila Vedamaththaya had spectacular
success in setting broken bones derived from a secret recipe,
which had been in his family since the days of King Dhatusena.
(Weekend. 5.4.1981 p 10) In 1950 a commission inquired into this
system. Practitioners stated firmly, that desiya chikitsa
is not an offshoot of ayurveda as popularly supposed. It was an
independent system of medicine with its own drugs, diagnostic
methods and treatment.( (SP 17,1950) Uragoda stated in 1987 that
there still were a few village practitioners who knew some of
the desiya chikitsa remedies. These remedies had been
declared effective by knowledgeable observers. The practitioners
however refuse to divulge the formula and let these
prescriptions die with them.
Sources are M. B. Ariyapala, Society
in medieval Ceylon, J. W. Bennett Ceylon, and its capabilities.
W. 1. Siriweera Hospitals in ancient Sri Lanka, Daily News
2.4.2003 M. P. Tillekeratne. Manners, customs and ceremonies of
Sri Lanka. V. Vitharana. Sri Lanka the geographical vision.
References from R. A. I. H. Gunawardana were taken from three
sources, Sri Lanka Journal of Humanities 4, 1978; Sri Lanka
Archives, 1, 1983 and Kalyani 3,1984. References from C. G.
Uragoda are from: History of Medicine. Traditions of Sri Lanka
and Science Education series no 36 published by the National