Medical feats of the ancient Sinhalese

The Sinhalese medical tradition harkens back to well over 2000 years. Besides a number of medical discoveries that are only now being acknowledged by western medicine, the ancient Sinhalese are perhaps responsible for introducing the concept of hospitals to the world.

According to the Mahavansa, the ancient chronicle of Sinhalese royalty written in the 6th century A.C. King Pandukabhaya (4th century B.C.) had lying-in-homes and hospitals (Sivikasotthi-Sala) built in various parts of the country after having fortified his capital at Anuradhapura.

This is the earliest literary evidence we have of the concept of hospitals (i.e. a special centre where a number of patients could be collectively housed and treated until they recovered) anywhere in the world.

Prof. Arjuna Aluvihare ("Rohal Kramaya Lovata Dhayadha Kale Sri Lankikayo" Vidhusara Science Magazine, Nov. 1993) contends that there is no evidence, literary or otherwise, to show that hospitals were known elsewhere before and during the time of King Pandukabhaya.

According to Prof. Aluvihare, the oldest archaeological evidence we have so far of a hospital is in the ruins of Mihintale, where the remains of a hospital built in the ninth century could still be seen.

The layout of the building and the discovery of a medicinal trough and surgical instruments proves this beyond doubt.

Heinz E Muller-Dietz (Historia Hospitalium 1975) describes Mihintale Hospital as being perhaps the oldest in the world.

All medieval Sinhalese hospitals so far discovered appear to have comprised of a central courtyard surrounded by cells for the treatment of the sick and an adjoining second courtyard with surrounding rooms which were used for the storage and preparation of medicines, besides other purposes.

Ancient and medieval Sri Lanka it should be noted, had a corporate social organization where the state provided welfare services to the people in return for the corvee labour provided by masses to build irrigation works, palaces and religious edifices.

As such the state provided free medical care to all its citizens regardless of race, caste, sex, religion or status. Although traditional Sinhalese medicine has a number of distinctive features, it is primarily based on the science of Ayurveda (a Sanskrit term meaning "science of life") an essentially herbal system set forth in the medicinal texts (Sanhitas) of the great Indian physicians, Shushruta and Charaka who lived about the same time as the "Father of modern medicine" Hippocrates the Greek.

Ancient Sri Lanka"s extremely cordial relations with Mauryan India would have considerably helped facilitate the dissemination of the great Indian medicinal tradition amongst the local population.

King Asoka"s (3rd century B.C.) Girnar rock edict states that he provided medicines and medical aid for both men and animals as far as Tambaparni (The old Indian name for Sri Lanka).

However, in spite of the profound Indian influence, Sinhalese medical knowledge has developed on is own course with the passage of time and we note a number of distinctive features, which mark it out from other medical systems.

We come across a number of references to medicines and medical treatment in the ancient Sinhalese chronicles. According to the Mahavansa, prior to the birth of her son Dutugemunu, Queen Viharamahadevi gifted medicines to the Buddhist clergy in order that she may conceive.

The same work alludes to King Dutugemunu having donated food and medicine to the sick.

King Buddhadasa (340-368 A.C.) the country"s renowned physician- king was adept in general medicine, surgery, midwifery and veterinary medicine.

The king"s surgical operation on an outcaste (Chandala) woman in order to deliver her child and the surgical removal of a lump in the belly of a snake are some of the feats narrated of this remarkable monarch in the sequel to the Mahavansa, Chulavansa. The chronicle states that the king constantly carried a set of surgical instruments with him on his journeys. It speaks well for the nobility of this king who casting aside ancient prejudices " unimaginable in those caste-ridden days " to have attended on an untouchable female.

This in itself shows that the Sinhalese medical establishment of yore considered service to humanity to be such a sacred and estimable duty as to even transcend caste barriers, which were otherwise strictly observed at the time.

The king"s surgical feats on a helpless serpent also shows that not only humans, but also other creatures benefited from the medical skills acquired by the ancients.

The king is also stated to have given medical professionals due remuneration for their services to the people. The Chulavansa states that the king "gave the physicians the produce of ten fields as livelihood."

The compilation of the "Sarartha Sangraha", a comprehensive medical treatise in Sanskrit is also attributed to King Buddhadasa. Although this work is similar in arrangement to the Sanhita of Shushruta, it contains much original information as well.

The work deals with the preparation of drugs, clinical diagnosis, surgical instruments and operations, ear, nose and throat diseases, eye diseases, tuberculosis, insanity, epilepsy and obstetrics, besides a number of other subjects of medical importance.

King Aggabodhi VII (766-772 A.C.) even went to the extent of undertaking fresh research pertaining to medicinal substances. According to the Chulavansa, the king "studied the medicinal plants over the entire island of Lanka to ascertain whether they were wholesome or harmful to the sick."

King Mahinda IV (956-972 A.C.) is said to have distributed beds and medicines to all the hospitals of his realm.

King Parakrama-Bahu I (1153-1186 A.C.) who was also well versed in medicine helped qualified physicians practise their skills by providing them with due maintenance.

It is thought here necessary to give a more detailed explanation of the Sinhalese Hospital tradition to provide an idea of the extent to which the Sinhalese had advanced in hospital care. The ninth century Mihintale hospital which has the distinction of being the oldest hospital yet discovered in any part of the world as seen earlier, was quite a complex structure.

The hospital is believed to have been founded by King Sena II (851-885 A.C.) on the basis of evidence in the Chulavansa.

As shown by recent archaeological excavations the hospital complex comprised of an outer and inner court.

The rooms used for the preparation and storage of medicines and the hot water bath were situated in the outer court. The discovery of stone querns used in the grinding of herbs in the outer court area suggests that the preparation of medicines took place thereabouts.

The inner court in common with later hospitals, was surrounded by a number of cells where the patients appear to have been treated.

A slab inscription of Mahinda IV (956-972 A.C.) near the hospital alludes to physicians; physicians who apply leeches and dispensers of medicine. Other hospitals of the medieval period which have been excavated are the Medirigiriya and Polonnaruwa hospitals.

Excavations at Mediri-giriya, where a hospital is believed to have flourished in the ninth century, have revealed a stone medicine trough and querns for grinding medicine.

Excavations at the Polonnaruwa hospital site have revealed medicine grinders, a pair of scissors, ceramic jars for the storage of medicines and a hooked copper instrument which was probably used for incising abscesses.

The construction of the hospital is assigned to King Parakramabahu I (12th century).

Literary and epigraphic evidence however indicates there were many more hospitals and other institutions for the handicapped in existence in ancient and medieval Sri Lanka.

According to the Chulavansa, the kings Buddhadasa and Upatissa II built institutions for cripples and hospitals for the blind.

Upatissa II was probably also responsible for building the country"s first ever maternity home, while Kasyapa IV had specialized hospitals built in Anuradhapura and Polonnaruwa to combat Upasagga, which is believed to have been an epidemic disease.

An inscription attributed to King Kasyapa V (914-923 A.C.) records the establishment of "medical halls" in Anuradhapura.

As borne out by the Kiribathvehera pillar inscription attributed to King Kasyapa IV (896-913 A.C.), the dispensary was such a hallowed institution that it had the privilege of affording sanctuary to offenders.

As Dr.C.G.Uragoda (A History of Medicine in Sri Lanka,1987) notes: "This is indeed a privilege of a high order if one considers other institutions which have enjoyed similar time honoured positions, namely churches in medieval Europe and embassies." As for the efficacy of local medicine this is borne out by a number of western authorities right down from the Portuguese colonial period (16th-17th centuries).

Joao Ribeiro, the famous Portuguese soldier-historian who served in Sri Lanka from 1641-1658 has written in his reputed work "Fatalidade Historia de Ceilao".

"They are great herbalists, and in case of wounds, tumours, broken arms and legs they effect a cure in a few days with great ease. As for cancer, which is a loathsome and incurable disease among us, they can cure it in eight days, removing all viscosity from the scab without so much as leaving a mark anywhere to show that the disease had been there. I have seen a large number of soldiers and captains cured during my residence in the country, and the ease with which this was done was marvellous.

In truth the land is full of medicinal herbs and many antidotes to poison, which I have myself tried to learn as a remedy against snake-bites."

Dr C.G. Uragoda ("A scientific basis for some traditional beliefs and practices in Sri Lanka". JRAS SL. 1989/1990) has shown that a good deal of traditional Sinhalese medical concepts, practices and drugs have a sound scientific basis.

The concept of heaty (giniyam) and cooling (sitala) foods is one such example. Dr Uragoda has shown that a variety of fish such as skipjack (Sinh. Balaya) and tuna (Sinh. Kelavalla) which are traditionally regarded as heaty, have a high histamine content, a substance which causes allergic reactions amongst some people.

He has also shown that olden day Sinhalese folk knew that the malaria parasite was transmitted by the mosquito long before 1884. When Sir Patrick Manson propounded the theory that the malaria parasite was transmitted through mosquitoes.

As evidence he has cited an interesting passage in Sir Emerson Tennent"s Ceylon (1859) which alludes to the Sinhalese of the time employing mosquito curtains as a precaution against malaria.

This would indicate that the Sinhalese knew that the mosquito was the vector of malaria at least 25 years before Manson advanced his famous Mosquito-Malaria theory.

Smoking of adhatoda vasica as treatment for excessive phlegm and use of coscinium fenestratum (Sinh. Venivel) as a prophylactic against tetanus are some of the traditional remedies cited by Dr Uragoda which have a sound scientific basi

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