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OBSTETR.ICS Basis of Systematically Collectsd Data and with the Aid Cf OBSTETR.ICS .r\.UD 1'nEORIES OF F:l~PRODUCTION IN AIWI~'N·r AND E:\RLY MEDI:ZVAL SRI LAiiiU.. Tho1.1.gh both literary testimony and archaeologicf41 remains ~ ,, point to the high priority assigned to the provision of m~ai.oa'i' care in the civilization which evolved and flourished for more than a millenuium in the "Dry Zone" of Sri Lanka, historians have paid or!ly scant attenticn to the task of assessing the progress made in medical science in this civilization. The nature of the available source material on the Sltbject, which is limited as well as ·scattered and presents formidal~lc problems of interpretation,· is obviously a noteworthy factor which has deterred progress in this field of investigation.. But this does not by itself explain away the limited interest shown b:t scholars in a f~eld that is as significc.;.nt as it / is interesting. Of the two main eontributions on the subject, the pioneer work of the late Profsssor s. Paranavitana is the more f! noteworthy. In a pe.pe:r entitleii "Medicine nnd Hygiene as Practised in Ancient Ceylon," publiohed in 1953, he b:r.:ought together data 1 pointing to the provision of medical care. In the Culture of C~ in }~ediaeval_'fl.~t written much earlier than :Paranavi tana' s work but :publ5. sl':ed only in 1960, Wilheln Geiger ut:i.lized material elici teci from the Pali chronicl0s to give a zhort account of what he termed 11Medical Science and ifi8dical Art 11 as practised in pre-colonial Sri Lanka. 2 The task of ascertaining the levels attained in the field of medicine and in the allied branches of knowledge on the basis of systematically collectsd data and with the aid cf compa.r.a-L.i.ve matarial from othe~ civilizations r~ca1ns yet·a desiderat~m of hif•to:dcal scholarship in Sri Lanka~ The present paper is only an inil~tal td;temrt i ac\.mi ttedly limited. in· its scop~, towards the acco.mplislm:~Cmt of· this task. The veja, or the mt:dica.l pre:.(, iii tioner was une of the earliest spe:cie.lists in Sri Lankan society. The term ve,ja and .:its Pali eq~i valent yej.)a were used to denote physicians • surc;eons as welJ as veterinarianso The term veja occurs for the first time in two ins­ criptions fo1md in the Putta.lam and the Hen:bantct;a Districts an\ assigned to a ~eriod extending from the 3rd century E.C. to th~~ beginning of the Christian era) By t11e fo~trth century A.D. inGti tutionalized provisions for mP.dical cta:e were known. r.rhe PROJ REPORT chronicles credit King :Euddhedaea (A.D. 340-368) with the establ1.~h- 121 (i) ment of vejjasala or 11 raedical halls" in the rural areac. He aplJOinteci physicians, one for each group of ten villag~;:s, to minister to the - 2 - sick. He also appointed veterinarians to treat horses and elephants.4 The contexts in which the term vejjasala and its Sinhalese equivalent ved-hal occur indicate that they denoted hospitals. A' tenth century inscription at Madirigiriya makes arrangements for the provirlion of mutton and chicken to the ved-hal.5 In the same century Mahinda IV distributed medicines and beds among all the vejjasala in the island.6 In the reign of Parakramabahu I (A.D. 1153-1186) each inmate at a hospital was assigned two attendants. The king used to visit hospitals on Poya days to comfort the sick and to encourage the cleverer among the doctors with special rewards.7 S9ffie of these hospitals were specialized institutions. In the tenth century Kassapa IV erected hospitals at Anuradhapura and 8 Polonnaruva for "complicated diseases." And among the institutions founded by Upatissa I (A.D. ·368-41 0) were maternity homes (pasavantiL~ sala).9 This is the first definite reference to this type of institution which is the most relevant for the present study. Apparently, the term timbiri-ge, which occurs in epigraphic sources, also denoted the same type of institution. The Dhampiya A~uva Ga~apadaya, the Sinhalese commentary on the Dhammapada~thakatha, written in the 10 tenth century, equates timbiri-ge with the Pali sutighara and, . as such, there is little doubt that the term denoted a "maternity home." Etymologically, the term timbiri-ee could mean "darkened or unlighted house" and, if this meaning is accepted, it would seem that maternity homes were windowless structures. The word timbiri also means ebony and it is possible to suggest another possible interpretation: that ebony wood was used in the construction of maternity homes. Curiously enough, Indian medical texts suggest that this latter interpretation, which at first seems far fetch~d, 11 is in fact the more plausible. According to Su~ruta,' · the four major caste groups or the ~~ were to use four different types of wood for building maternity homes, and ebony was the wood prescribed for the vai~yas. The Carakasa~hita does not specify different types of wood for each of the ~~~ but mentions ebony among the various types of wood it recommends for use for building maternity homes. The type of wood used for the construction of the building was also to be used to make furniture and other equipment for the maternity home. The text specifies that the building should have windows. The expectant mother was to move in there in the ninth month of pregnancy and live there till after - 3 - childbirth.12 If, on the basis of this evidence, the second interpretation is accepted, it would imply that the term timbiri-ge denoted maternity homes built of ebony which were prob~bly meant for the use of a social group of a particular ritual status. An inscription of unknown provenance and presently preserved in the National Museum at Colombo records the' construction of a timbiri-ge by Senalnakan, the Chief Secretary of Kassapa IV. An estate called Ganagami in the Valviti division of the Nothern Province • • (utur pasa) had been granted for its maintenance and, in the eleventh regnal year of this king (A.Do 908), it was awarded several privileges 1 by a royal grant. 3 There is another reference to a maternity home in the~escription of the reign of Parakramabahu I in the Culavamsa.- • This king is said to have erected a stupa in Punkhagama at the site 1 of the maternity home where he had been born. 4 The VaJ!lsatthappal::asin1,- ~ the commentary on the llahava111~'- uses the term vijayanaghara, a synonym for sutighara, to refer to maternity homes. Vlhile commenting on a passage in the ......-...o..;;.o__..._l.!ahavamsa v1here it is stated that Pandukabhaya.. erected a building called sivikasala the Va~satthappakasini points out that it is possible to give two alternative interpret~tions of the term. It could mean either a 1 Saiva shrine or a maternity home. 5 Of course, this does not mean that there were maternity homes at the capital in the early years of the Anur:dhapura kingdom since it is not even. possible to be sure about the historicity of this king. Further, as evident from the co~~ents in the Va~sat~h~ppak~sini, the meaning cf sivikasala is itself not clear. Hence the information in the Va!llsC~.t~haEpakasin[ is useful only as an indication of the prevalence of maternity hQmes at the time this work or the sources on which it was based came to 16 be written. The maternity homes mentioned in the Indian medical texts appear to have been private buildings. In fact Caraka gives special insttuc­ tions that the work on the construction of the maternity home should 1 be started well before the ninth month of p:regnancy. 7 I·~ is possible that such structures specially built for the occasion, untainted by ritual pollution and suitable for rites de passage associated with the event, were used by the elite social groups druing this period. But most of the L!later:nity homes founded in the - 4- island from the fifth century onwards were meant for communal use. Institutions for the provision of medical care usually received funds for maintenance'from three different ways. Some were monastic I hospitals situated within monastic precincts and presumably maintained by the monastery. Some were royal hospitals founded and maintained by the state. There was still a third category of hospitals founded and endowed by private individuals. Understanda:bJ:y,there were no maternity homes within monastic precincts in Sri Lanka: they.were founded and maintained either by the state or by private individuals. It is thus clear that in ancient Sri Lanka the isolation of the expectant mother from the rest of the family was considered desirablJ. It provided her with an opportunity to rest as well as privacy during childbirth. It is likely that some experienced women were in constant attendance while surgeons were called in to attend to complicated cases. The Culavarnsa refers to such an instance when it describes King Buddhadasa treating·- a candala woman affected by the condition called muthagabbha.- 18 As Geiger-·- has observed, 18a mnthagabbha- can be compared with the Sanskrit term mu4hagarbha which occurs in Ayurvedic texts. Susruta who devoted two chapters in his work to this tor,J:c associates this condition with premature parturition and includes within it both breach and transverse presentation. Among methods of treatment he prescribed were internal version and, where this was not . 19 practicable, foetotomy. The Culavamsa·- does not provide information on the manner of treatment that Buddhadasa adopted, but it reveals a ~~owledge of abnormal types of parturition and also supports by lmplication the idea that a.
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