Sanitation and healthcare in ancient Sri Lanka

Prof. W I Siriweera

Continued from last week

The techniques of the construction of toilets and lavatories developed over several stages. A highly developed stage in this process is discernible in the constructions at the Abhayagiri complex in Anuradhapura and at the Baddhasimapasada and the Alahana Pirivena hospital complex in Polonnaruwa. The toilets and baths at Abhayagiri have been constructed at a distance from the residences of the monks while those at the Baddhasima Pasada; and the Alahana Pirivana hospital complex have been built adjoining the residential quarters of monks. Extra toilets with ring-well pits have been built in the periphery of the hospital, most likely for the use of staff and visitors.

At both monasteries liquid passing through urinals was diverted into pits along terracotta pipes. In the urinary pits at Abhayagiri, large bottomless clay pots of decreasing size have been placed one above the other. There are signs that these pots contained sand, lime and charcoal through which urine filtered down to the earth in a somewhat purified form. There had been seven pots in certain pits but the number had been fewer in some others. The pots had been vertically fixed together with a mixture of cement and clay. These urine pits point to the attention paid by construction engineers to the details of sanitary care and environmental protection.

Water and urine have been diverted from the toilets of Baddhasima Pasada at Polonnaruwa through terracotta pipes into a separate septic pit while excreta was diverted to another septic pit. The toilets and lavatories at the Medirigiriya monastery were located at a considerable distance from the residential quarters and the hospital complex.

Diseases and Treatment Methods

The ancient texts refer to many kinds of illnesses caused by disturbances of the wind (vata), bile (pitta) and phlegm (slesma). Of these, there were several kinds of fevers, and the chronicles indicate that some of them were contagious. Fatalities from such contagious diseases are referred to in the reigns of Sri Sanghabodhi (247 - 249), Upatissa I (365 - 406), Kashyapa IV (898 - 914) and Kashyapa V (914 - 923).

Several forms of treatment were practised in ancient Sri Lanka. Initially these were based on the North Indian Ayurveda system, but later on the South Indian system of Siddha medicine also came into vogue. With Muslim influence, the Yunani system, too, played a role in curative medicine, particularly among the Muslim community who established trading posts in the coastal areas in the thirteenth, fourteenth and fifteenth centuries. The oral administration of drugs, external applications, inhalation, fomentation, suction of poison, bandaging, steam and hot water therapy, immersion therapy and surgery were some of the curative methods used for different kinds of illnesses. Resorting to rituals for curing diseases also existed side by side with other forms of treatment, but there were at least a few in society who considered them as base and primitive (gupta vidya).

Immersion and Hot Water Therapy

Among the methods of treatment, immersion therapy, hot water and steam therapy and surgery deserve special attention. The granite receptacles carefully scooped out to conform to the contours of the human body found in almost all ancient hospital complexes, have been used for immersion therapy as prescribed in texts such as the Caraka Samhita, Susruta Samhita, Samantapasadika, Yogarnavaya and Prayogaratnavaliya. Immersion in droni or receptacles filled with heated milk, essence of meat, vegetable stock, oils, vinegar, ghee, etc., has been recommended in the Ayurveda texts for a variety of illnesses such as skin diseases, fevers, haemorrhoids, fractures as well as post-surgical care.

The ruins of buildings known as the Jantaghara constitute hard archeological evidence which confirms the practice of hot water steam therapy (sveda) referred to in the Pali texts Majjihimanikya, Abhidanapadipika, Pali Muktaka Vinaya Vinicca Sangaha and also the Indian and Sri Lankan Ayurvedic texts. Individual patients could use this therapeutic form with the help of an attendant without the supervision of a physician. The heating of body with steam, or bathing in hot water after application of medicines in order to intensify perspiration, were important aspects of this form of therapy. Some of the best examples for well preserved foundations of Jantagharas can be seen behind the famous Samadhi statue at the Abhayagiri monastery and at the Arankale monastery. A Jantaghara consisted of a central cistern with a ledge. This ledge was used as a seat for the person who was bathed by one or more attendants. Hot water and steam were generated in the site itself and there were well laid-out drainage systems for waste water.

Surgery

The surgical skills of King Buddhadasa (337-365 A.D.) to whom the authorship of the well-known medical treatise Sararthasangraha, has been ascribed, are illustrated in the legendary tales found in the chronicle. The fifth century commentary Visuddhimagga of Buddhaghosa while explaining the tenfold skills required for concentration of mind, cites the manner in which persons are trained in surgery. It states that a skilled student who has developed concentration of mind uses the scalpel on a lotus leaf in a dish of water, and leaves the scalpel mark without the leaf being pushed under water, whereas the one who has not been trained on the concentration of mind is scared even to touch the scalpel. A Sinhala text datable to a period between the eleventh and the thirteenth century, the Karmavibhaga, contains a clear reference to foetology. While describing the sufferings a human being has to undergo at birth, this text states that the foetus will be torn to pieces with sharp instruments if it assumes a transverse position at the time of birth. These textual references to surgery have been corroborated by the discovery of probes, forceps, scissors, scalpels and a lance at the Polonnaruwa hospital complex datable to the twelfth century. They have been made out of bronze or iron with a small percentage of steel.

Some kings not only patronized the health sector, but also engaged themselves in research on aspects of medicine. For instance, in order to test their efficacy Aggabodhi VII (772-777) conducted research on the medicinal plants of the island.

In a discussion on healthcare, some references need to be made to veterinary care as well. The Mahavamsa story of the war between Dutthagamani and Elara states that in the battle of Vijithapura, a soldier of Elara poured molten pitch on the Kandula elephant, and that the wounds were immediately treated by veterinarians. King Buddhadasa (337-365 A.D.) appointed veterinarians for treating elephants and horses while he himself cured a diseased cobra and a horse. The commentary, Papancasudani, written by Buddhaghosa in the fifth century A.D., states that a clever herdsman ought to be able to remove fly-eggs (asatika) from the wounds of animals under his care and to cleanse and fumigate cow-pens regularly in order to dispel insects. King Parakramabahu I (1153-1186) is said to have cured a crow suffering from an ulcer that had formed in its cheek.

These instances demonstrate that the care taken over the health of animals was as well organized as that of humans in the days of the Rajarata civilisation.