Midweek Review

Health and medicine in ancient Sri Lanka
by Kamalika Pieris

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 and medicines.

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 baths.

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 first aid.

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 filtration.

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 Science Foundation.


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