CHAPTER- III THE EVOLUTION OF THE HEALTH POLICY UPTO 194-8 CIN BRIEF) 3,1 INTRODUCITON Sri Lanka's civilization goes back to over 2500 years. Fortunately, the country has a recorded history, according to which migrants from India settled dovm in the North Western areas of the country before the Christian era. The most significant event in the history of the island is the introduction of Buddhism in the Third Century B.C. This enabled the people to build a culture of their own and develop all aspects of their life. The close contact with India brought not only Buddhism, but also Hinduism, Ayurveda, Astrology and various other important aspects of Indian Culture. People came from India for trade as well as for political purposes; some to assist their friends, the kings of the country. Others to bring the country under their rule, added much to socio-cultural inheritance of Sri Lanka. In the Sixteenth Century (1505), the Portuguese came to the island. After they ruled the country, the Dutch followed and they were replaced by the British who first ruled the maritime provinces, and then the entire country 1815 to 1948. Sri Lanka gained independence in 1948 and till today functions as a democracy. It is pertinent to mention that of all the coiintries in South-Asia, Sri Lanka and India are the two countries where democracy function continued to uninterrupted. 195 The history of medicine in Sri Lanka has been fashioned over the centuries by a synthesis of several intrinsic and extrinsic factors, some of which were unique to the country. Being an island, Sri Lanka was insulated to a large extent from external forces influecing medicine. But India, Portugal, the Netherlands and finally Britain succeeded at different times in penetrating this nature barrier. The systems of medicine, and the cultures they introduced have been largely determined the state of medicine in the country today. The recorded history of Sri Lanka dates from the arrival of King Vijay and his band of settlers from North India in the Sixth Century B.C. However many historians and archaeologists consider that the authentic history begaun in the third century B.C. with the introduction of Buddhism from North India during the reign of King Devanampiyatissa, a contemporary of the Mauryan Emperor Ashoka of India. These two events have had a profound influeced in shaping the history, including that of medicine of the country. Facets of India-Aryan culture that flowed into the country in the wake of Buddhism included the learned languages, Sanskrit and Pali, in which the well established system of Indian medicine, Ayurveda texts were written. Whatever indigenous system that prevailed before was gradually supplanted by Ayurveda with its centuries old heritage. The subsequent South-Indian invasions that took place till the twenth century did not have much impact 196 on medicine. However, the system of Siddha medicine may also have found its way into the country through India. The advent of the Portuguese have been brought the first real contact with Western medicine. The progress in navigation in early years brought ships of many nations to Sri Lanka; but there is no evidence that these trade contacts afforded any significant exposure of the local population to Western medicine before the Portuguese period. The influence which the Portuguese brought to bear on local medicine was marginal, but the Dutch, especially towards the later part of their rule, had made some impression on medical system. The British made a tremendous impact on the medical system. It is to their credit that they, \inlike their predecessors, have taken aua interest in the health of the people; and by their activities transformed the entire medical scene in the country. Western medicine and Ayurveda are now being practised side by side. While Buddhism was the driving force behind the provision of health facilities to the people under the ancient Sinhala Kings, Christian attitudes have been influenced to some degree the health care systems of the Portuguese and the early British. The Portuguese have established throughout their empire an institution known as "Miseri-Cordia", which acted as a social service organization. It has drawn support from the different Catholic orders, as well as the government. One of its functions 197 was to help in running hospitals. One of its functions was to help in running hospitals. During early British rule, the Anglican church has sponsored Friend-in-need aocieties which later established hospitals. The British, for well over a century of their occupation, imported South Indian labour to work their plantations. Further, the attitude of the British, who considered the health of the plantation workers as an economically important factor which had to be safeguarded at great odds, was a major element in the development of the health structure in the country. 3.2. PRE-HISTORIC MEDICAL PRACTICES It is traditionally believed that Ravama, the pre-historic king of Lanka of Ramayana fame was well versed in medical lore. It is mentioned that he represented Sri Lanka at a Medical Conference held in India during his time. Ravana is believed to have been the author of several books of medicine, the best known of which were Arkaprakasaya, Nadivignanaya, kumarathanthraya and Udishasastraya (Wijerama, E.M., 1952, p. 46). The majority of medical plants used in Sri Lanka are the same as those currently used in India. This common ground may have given rise to the popular legend that certain forested hills, e.g. Doluwakanda and Rumassalakanda, from which drug plants are often collected, are only fragments of a part of the Himalayas that was carried over to Sri Lanka by the mythical monkey-king, Haniiman to provide drugs for the wounded in the 198 Rama-Ravana battle (Abeywickrama, B.A, Dasanayaka, M.D., Fonseka, R.N. - 1964, pp. 41-45). Escavations which normally aim at revealing a country's past, have recently shown a diversification in Sri Lanka. Pre-historic burial sites have been discovered in several places in the country, the better known among them being Pomparippu and Bellan Bandi Palessa. These testify to the fact that pre-historic man in Sri Lanka was conscious of the concept of cemeteries. It is believed that there is be some affinity between the Pomparippu burial complex and the Iron age (megglithic) culture of South India (Begley, Vimala ©£ al., 1981, pp. 49-132). In 1919, Paul, E. Peris, in his excavations at kantarodai in the Jaffna Peninsula has discovered some interesting structures. These were a series of copper rods (Peris, P.E. JRASCB - 1919, p. 28). Similar artefacts were also found at Gedige at Anuradhapura. (Deraniyagala, S. 1972- p. 145) and at Pomparippu. (Begley, Vimala, op. cit., p. 75). At the latter site, some of these slender rods, made of copper alloy, were as long as 190 mm. Each had a head, while one end tapered to a point. These rods from all these there sites were identified as kholsticks on the basis of similar rods found in Egypt. Khol was applied by ancient Egyption ladies to blacken the edges of eyelids. Several kinds of khol were used for their real or supposed medcinal properties. 199 3.3. MEDICINE AND HEALTH POLICY UNDER ANCIENT KINGS Sri Lanka was ruled by its own kings from the inception of its written history until. 1815, when the British annexed the kandiyan kingdom. There was juxtaposition of Sinhala sovereigntly side by side with foreign rule from 1505 to 1815. This long continuum of over two millennia of reign by king of Sri Lanka makes it appropriate that one should consider the ancient and mediaeval history of medicine of Sri Lanka in brief restricting the coverage to only the pre-Portugese era. Considerable information on the structure of the medical system and the policy of health that prevailed during this period is available from literary and archaeological sources. The ancient chronicle, the Mahawamsa is the richest single source of such information. The second most fruitful soure of information pertaining to early history of medicine in Sri Lanka were the inscriptions. The earliest inscriptions, so far discovered were from the reign of king Devanampiyakissa, who ruled from 247 to 207 B.C. A few inscriptions mentioned facts of medical interst. (Uragoda, C.G. 1977, p.22). One of the edicts of Ashoka, engraved on the second tablet at Girnar, relates to the establishment of a sytem of medical administration throughout his dominions, and as far as Tambaparni (Sri Lanka) in which "both medical aid for men, and medical aid for animal, together with medicaments of all sorts, suitable for animal and men" were provided (Tennet, J.E. 1860, p. 504). One of the areas in which information is furnished by the inscriptions, as well as by the Mahawamsa, is that of ancient hospitals. 200 The concept of hospitals where a number of patients could be collectivley housed in special centres with the attendant advantages to the sick was recognised as early as the Fourth Century B.C. during the reign of Pandukabaya (MV, 10, 1912, 102). There is reference to a hospital for the laity by the son of Mahinda IV (956-972 A.D.) in Anuradha Pura (CV, 52, 1929, 57). However, there is no special mention in the Mahawamsa of hospitals for monks, but a hospital existed on Mihintale which was a monastic site; "On the Cetiya mountain he (Sena II, 851-885, A.D.) built a hospital" (CV, 51, 73). In Anuradhapura, medical institutions have been built by Pandukabaya, (MV, 10, 102) and Kassapa V (913-923, A.D.) (CV, 52, 57). In Pulatthinagara (Polonnaruwa) he (Udaya I, 792-797 A.D.) built a large hall for the sick.