Sanitation and healthcare in ancient Sri Lanka
Prof. W I Siriweera
Sanitary and healthcare facilities in Sri Lanka varied according to the status of social groups. The royalty, nobility and the elite priesthood lived relatively comfortable lives and enjoyed reasonably good sanitary facilities.
The extant evidence of porcelain ware, palace complexes, baths and pleasure gardens used by the royalty give an indication of living conditions of the royalty and the nobility. The remains of the major monastic complexes and ponds, wells, underground terracotta pipes, drains, toilets and septic tanks attached to them indicate that Buddhist priests in major monasteries enjoyed a relatively high level of sanitary facilities.
On the contrary, various references in Pali and Sinhala literary texts point to the hardships faced by the peasants and ordinary people. The living standards and conditions and sanitary facilities available to them and to the priests in temples in remote villages were rudimentary when compared to those of the upper strata of society.
Nevertheless, there is no doubt that regular bathing, brushing teeth, cutting long hair and nails, cleaning and sweeping the habitats and surroundings mentioned in texts such as Mahavagga, Samantapasadika and Sikhavalanda Vinisa in relation to Buddhist priests were relevant to all categories of lay society as well irrespective of their social standing.
It is due to developments of such habits and practices that Robert Knox was able to observe in the latter part of the seventeenth century, that the Sinhalese were an extremely clean people.
The Caraka Samhita as well as the Susruta Samhita pay particular attention to physical exercises. According to these texts a self-loving person should do physical exercises in all seasons to maintain lightness of the body, activeness and youthfulness.
A hot water bathing pond
The remains of an ancient pond
A washroom inside a cave used by monks in the past
An ancient medical spa
The Kandavuru Sirita written during the Dambadeni period indicates that the king too, was expected to do the same. The monks were supposed to perambulate in monastic compounds early in the morning. Thus the efficacy of physical exercise was well recognized throughout history.
The Arthasastra of Kautilya written during the fourth century B.C., was known and studied in Sri Lanka. While stipulating the ideal system of statecraft, this work refers to ideal rules and regulations to be adopted in health and sanitation management in cities.
Accordingly, dumping garbage, allowing garbage to pile up, leaving room for water to gather in one place, defecation in public places, disposing of dead bodies of such pets as cats in streets were strictly prohibited.
Similarly, the cremation of dead bodies in places not earmarked specifically for such purposes was prohibited. Offenders were to be punished by fining; the fines varying according to the gravity of the offence.
Whether such strict regulations were enforced in all Indian cities is doubtful. Their enforcement in Sri Lankan cities is even more doubtful. But what is important to note is that the concept of sanitation, hygiene and cleanliness of cities were recognized as priorities in both countries.
The Pandukabhaya legend in the Mahavamsa refers to the establishment of villages in the periphery of the city for five hundred Candala scavengers, two hundred of whom were entrusted with cleaning the sewers of the city, one hundred and fifty entrusted with removing dead bodies from the city and one hundred and fifty assigned to maintain graveyards.
These figures and the period to which they can be applied leave room for debate. Nevertheless it is certain that at least when the Mahavamsa was written in the sixth century A.D., healthcare in the capital city was well organized.
The remains of the ancient cities of Anuradhapura, Sigiriya and Polonnaruwa, too, clearly demonstrate the attention paid to the environment, sanitary conditions and healthcare. Water management in the environs during monsoon rains, the supply of water to the cities, the sedimentation and filtering techniques in ponds and canals, the discharge of used water out of the cities as well as garbage and refuse disposal had undoubtedly been arranged according to a set plan in each of these cities.
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).
A pond that was used for bathing purposes
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.
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