KURUNEGALA DISTRICT

M.C. Sri Wickramaratne (referred to earlier) indicated the possibility of there being traditional physicians practising cauterization and puncture in regions other than the Central and Southern provinces.  Information from Anuradhapura district in the North Central Province and from isolated villages in the North Western Province encouraged us to contact Ayurvedic physicians and make inquiries.  Most probably it was from the Kandyan highlands that knowledge in cauterization spread to these provinces.

Marga researchers making investigations in Kurunegala district met a 95-year-old physician who once administered puncture and cauterization treatments.  He had also been adept at pressurizing nila points.  He is physician R.M. Appuhamy of Wätiyawatta in Kurunegala district.

For seven generations his family has been practitioners of all aspects of katu chikitsā.  R.M. Appuhamy was once called to the bedside of a patient who was undergoing treatment in the hospital.  The doctors were unable to give him relief and had suggested a surgical operation which the patient was reluctant to have performed.  When Appuhamy came and pressurized certain nila points on the patient's body, instantaneously the pains ceased and the patient was cured.  In amazement the doctors asked Appuhamy if there was any favour they could do in return for his service.  'Nothing whatsoever', Appuhamy told them.

That was typical of the attitude which the older generation of Sinhalese villagers adopted in relation to their work.  Most of them worked for the sake of work and not merely for wages or in expectation of personal favours.

INSTRUMENTS

Appuhamy has several instruments for puncturing and cauterization.  Whenever a patient is brought for treatment, Appuhamy first administers pressurization of nila points and thereby tests whether he has located them correctly.  If pain subsides instantly he infers that the points are the right ones.  Then he marks those points with chalk.  They have to be punctured with his lēndiyā katuva instrument or cauterized with his bottam katuva instrument.  A curved piece of perforated coconut shell is used to ensure that the instrument touches the precise point.  The coconut shell is placed on the patient's body so that the point is visible through its perforations.  The instrument is then directed through one of those perforations.

It is in this manner that Appuhamy uses - or rather used when he was an active practitioner - these instruments which he had had manufactured according to his own specifications.  Incantations form part of his technology.  Now in his old age, he cannot pronounce some of the sounds which occur in the incantations.  This is another reason why he does not practise at present.

Figure 11 - Bottam katuva, button instrument - for cauterizing.  Steel.  Actual size approx. 9.1 centimetres long.  Note that, in this and other similar cauterizing instruments, the blunt end (at right) is the functional end; in use, the pointed end is commonly attached to a wooden stick, which serves as a temporary handle.  Made in 1950 by a blacksmith in Kobeygane (name unknown).  Present owner: R.M. Appuhamy Veda Rāla, Wätiyawatta, Kurunegala district.

Figure 12 - Bottam katuva - for cauterizing.  Steel.  Actual size approx. 9.2 centimetres long.  Made in 1950 in Kobeygane; maker's name unknown.  Present owner: R.M. Appuhamy Veda Rāla.

Figure 13 - Lēndiyā katuva - for cauterizing.  Steel with copper tip.  Actual size approx. 8.3 centimetres long.  Made in 1950 in Kobeygane; maker's name known. Present owner: R.M. Appuhamy Veda Rāla.

Figure 14 - Positioning guide - used to isolate the precise spot for puncture or cauterization; the needle or other instrument is inserted through the hole in the guide.  Coconut shell.  Actual size approx. 10.2 centimetres long.  Made in Wätiyawatta, Kurunegala district, by R.M. Appuhamy Veda Rāla.  Present owner: R.M. Appuhamy Veda Rāla.

His son, R.M. Herat Hamy, who resides at Wewagedera in Wariyapola, has learnt the use of these instruments, but he works only as a general practitioner of traditional medicine.  He has a copy of his father's palm-leaf manuscript on puncture and cauterization.  Other old manuscripts on medicine are also preserved in their home at Wätiyawatta.  Duplicates of R.M. Appuhamy's instruments are in the possession of physician R.M. Punchi Banda (age 65 years), a former resident of Wätiyawatta but now living in Awulēgama, Bayawa.

Following up on information received, our researchers went to the Folk Museum at Anuradhapura and saw cauterization instruments and puncture instruments: the lēndiyā katuva, the bottam katuva, the katuva for making chalk marks around nila points, the perforated metal piece.

These instruments probably belong to the seventeenth century.  Mr. A.B. Herat, Curator, Kandy Museum, had privately informed Mr. Sunimal Fernando, Consulting Sociologist, Marga Institute, that he had seen at Wellassa in Uva Province an old palm-leaf manuscript of the Salla Vidiya which appeared to be relevant to the purposes for which these instruments were intended.  The manuscript was in the possession of an old family which had produced traditional physicians of repute.  At present no one in that family practices Ayurveda.

Figure 15 - Bottam katuva - for cauterizing.  Steel.  Actual size approx. 8.2 centimetres long.  Place and date of manufacture unknown.  Present owner: Folk Museum, Anuradhapura (donated, 1973, by Dissanayake Tikiralage Wannihamy).

Figure 16 - Cauterizing instrument.  Steel.  Actual size approx. 9.2 centimetres long.  Place and date of manufacture unknown.  Present owner: Folk Museum, Anuradhapura (donated, 1973, by Dissanayake Tikiralage Wannihamy).

Figure 17 - Marking instrument - used to mark places to be treated.  Steel.  Actual size approx. 9.2 centimetres long.  Place and date of manufacture unknown.  Present owner: Folk Museum, Anuradhapura (donated, 1973, by Dissanayake Tikiralage Wannihamy).

Figure 18 - Cauterizing instrument.  Steel.  Actual size approx. 8.2 centimetres long.  Place and date of manufacture unknown.  Present owner: Folk Museum, Anuradhapura (donated, 1973, by Dissanayake Tikiralage Wannihamy).

Figure 19 - Tahaduwa, perforated metal piece - used to isolate spot for cauterization.  Iron.  Actual size approx. 9.2 centimetres long.  Place and date of manufacture unknown.  Present owner: Folk Museum, Anuradhapura (donated, 1973, by Dissanayake Tikiralage Wannihamy).

Ayurvedic Dr. K.S. Samarawickrama had his instruments made at Dikwella.  Mr. B.D. Siripala of the Kandy Kachcheri also had similar instruments made for his private use.  Ayurvedic Dr. K.M. Abeysinghe Bandara of Kailawala, Matale, obtained his instruments at Attaragama.  Ayurvedic Dr. D.L.C. Jālat Muhandiram of Agalaboda had instruments manufactured according to his specifications.  R.M. Appuhamy Veda Rāla of Wätiyawatta practised cauterization with instruments made in his village of Kobeygane in Kurunegala district.

Figure 20 - Multiple instrument set: (1) saw - steel; (2) chisel - steel; (3) puncturing instrument - bronze; (4) rod for cauterizing veins and joints - copper with gold and silver; (5) handle - silver.  Purposes not fully verified.  Actual size slightly smaller than 9.2 centimetres.  Made in about the seventeenth century; handle made by Disawe Muhandiram (Navandanna caste), near Dujapitiya, in Harispattuwa; maker and place of manufacture of the instruments unknown.  Present owner: Kandy Museum.

P.M.P. Abeysinghe in his book Agni Karma Vindhi (Colombo, 1934, pp. 2-6) has given illustrations, old Sanskrit names, contemporary Sinhalese names, and uses of cauterizing and puncturing instruments.

Figure 21 - Twenty-five instruments referred to in Sinhalese palm-leaf manuscripts. (Courtesy of the Colombo Museum Library).

Considerable inventive ability went into the manufacture of these instruments although they were based on descriptions given in the Susruta Samhita and Sarartha Sangraha.  Indian editions of the Susruta Samhita with illustrations of Ayurvedic surgical instruments were available in printed form in the 1920s and earlier.  Palm-leaf Sinhalese manuscripts of the Sarartha Sangraha also contained illustrations of instruments.  Dr. S. Ranasinghe of Kochchikade has a manuscript of the Sarartha Sangraha which has illustrations.  Illustrations of instruments are also given in one of the manuscripts in Dr. Anton Jayasooriya's possession.  A similar palm-leaf manuscript published by the Colombo Museum authorities gives illustrations of Sinhalese surgical instruments.

UP-COUNTRY ROOTS

It is no wonder that Jayasuriya Aratchi Patabendige Babanis, the southerner who travelled in the up-country, took so much interest in cauterization that he obtained for his private use such a handbook as the Salla Vidiya.  Line 3 of page 1 of his text says that he brought the manuscript from Wälkanayaya in Niyangama in the island's up-country hinterland known as Sinhale.

Our investigators visited isolated villages off Kandy and spoke to elderly residents.  They stated that Niyangama was a village near Gampola and that a family of physicians had lived there long ago.  But whether they were specialists in cauterization techniques no one could say.  The majority of the residents of Niyangama belong to the Wahumpura caste.  When our investigators went to Niyangama and met senior villagers they confirmed that there had been a family of physicians residing in Niyangama and that their descendants had long ceased to practise medicine.

The only vestige of their family house had been the bare floor which remained after the roof and the walls had fallen in.  In 1947, when the floods came, even that floor was washed away, leaving human memory as the only record of the Niyangama physicians who healed the sick once upon a time.

It was in Sinhale, the hilly region of the island, that Sinhalese traditional lore was treasured in the post-fifteenth century era.  Medicine had been taught and practised in several villages around Matale - the best known being Ussattava, Pilihudugolla, Ambul Ambe, and Hapuvija.  The last named village had alternative forms of spelling such as Sapuvida, Sapuvija, Hapuvida, Hapuvija.  The Gazeteer of the Central Provinces of Ceylon by A. Lawrie (2 vols., Colombo, 1898) mentions these villages as being near Matale.  It refers to Niyangama as a village in Kandukara Pahala Korale in Uda Palatha.  Ussattava gained in reputation when the leading physician of the village cured an Indian visitor who was suffering from a malignant bowel disease.  Students who were apprenticed to that physician later established branch centres of the Ussattava school of medicine in villages such as Pilihudugolla, Ambul Ambe, Hapuvija, and Attaragama.  At each branch, physicians continued to practise but Attaragama developed faster than the others.

ATTARAGAMA

Attaragama the Raja Maha Vihara became a centre for the study of traditional medicine.  In course of time the other centres tended to attract less and less public attention while Attaragama gained in reputation.  The monks there gave general treatment according to Ayurvedic tenets for common ailments.  Occasionally there were patients for whom either cauterization or blood-letting by puncture of nerves was necessary after other treatments had failed to cure them.  In such cases puncture or cauterization was administered by the monks.  But textbooks on these and other branches of traditional medicine continued to be studied by the students who enrolled from time to time.  At the end of each course of study it was customary for a convocation ceremony to be held.  The chief monk addressed the graduates and admonished them to continue the noble example set by the founders of their parent body, namely the Ussattava school of medicine.

Thus Attaragama graduates established branch dispensaries and clinics at Dummalagahadeniya, Gampaha, Hali Ela, Kotte, Kiriwattuduwe, Kelaniya, Katana, Kandy, Matara, Matale, Negombo, Sembukuliya, Ukuwela, Walahapitiya, etc.  Our investigating officers had the good fortune to meet one of them - Mr. K.M. Abeysinghe Bandara (age 52 years) of Weragama, Kaikawala off Matale.  He supplied ample information about practitioners of traditional medicine, especially about those who did cauterization and puncture in addition to rendering ordinary treatment.

Mr. Abeysinghe Bandara himself is an expert at cauterization and blood-letting.  He is normally a general practitioner, but on rare occasions when patients who found that other techniques did not cure thei aliments came to him he administered either cauterization or blood-letting or both.  He showed our investigators the instruments he used.  They had been manufactured at Attaragama.  His most recent case was a male teacher from Bandarapola whose complaint was intense neuralgic pain.  He was given cauterization treatment on 15 February 1980.  On a  previous occasion there was a female patient who had been intermittently suffering from migraine headaches for ten years.  When cauterization was administered she was relieved of all pain.

Figure 22 - Pilissum katuva - for cauterizing.  Copper.  Actual size approx. 9.2 centimetres long.  Made in 1949 in Attaragama by Wijendragedera Ran Naide, blacksmith.  Present owner: Ayurvedic Dr. K.M. Abeysinghe Bandara, Weragama, Kaikawala.

Figure 23 - Valaya shalaka - used for cauterizing around the navel.  Iron.  Approximately 23 centimetres long; ring approximately 5 centimetres in diameter.  Made in 1949 in Attaragama by Diddeniyegedera Abaranu Appu, blacksmith.  Present owner: Ayurvedic Dr. K.M. Abeysinghe Bandara, Weragama, Kaikawala.

Figure 24 - Vilekhā - for slitting open veins.  Iron.  Actual size approx. 8.9 centimetres.  Made in 1949 in Attaragama by Diddeniyegedara Abarana Appu, blacksmith.  Present owner: Ayurvedic Dr. K.M. Abeysinghe Bandara, Weragama, Kaikawala.

Mr. Abeysinghe has found that while hernia, migraine headache, sanni illnessess associated with maternity, and epileptic fits can be cured by cauterization, blood-letting is effective in instances of boils, abscesses, and certain types of eczema.  In reply to a query by one of our researchers, Mr. Abeysinghe said that a physician who administered cauterization in the traditional way used to live at Walmoruwa off Naula in Matale district.  He was also adept at pressurizing nila points on the body to relieve pain.  The physician died sometime ago.  His wife continues to administer the treatment of pressuring nila points.  She does not do cauterization.  She is popularly known as the Lady Physician of Walmoruwa.

MĀLAGAMMANA

Our investigators paid a visit to Venerable Werallagama Dhammaloka Thero (age 79 years), head of the Raja Maha Vihara Temple, Mālagammana, Nugewela (Kandy district).  He stated that he was a general practitioner of the traditional system and that as such he did not practise puncturing and cauterization.  Yet he was fairly conversant with the literature on the subject.  The temple has a fairly large stock of manuscripts and printed books on traditional medicine.  The physician-monk picked from a shelf a palm-leaf manuscript and turned to a page marked with the Sinhala letter dai.  It contained the chapter heading 'Salla Vidiya', which meant that in that chapter of the manuscript treatment with surgical instruments was discussed.  After Attaragama Temple ceased to be a centre for healing the sick, Mālagammana Temple appears to have taken up the service of healing the sick.  Only saravānga vedakama (general practice) was done at Mālagammana Temple.

Like Attaragama Temple, Mālagammana Temple belongs to the Siamese sect.  The chief incumbent monk, Venerable Dhammaloka, considers it a privilege to help people to recover from illness especially because villagers have confidence in his healing skills.  They call it at gune (translated: gifted hands) - the born physician's intrinsic capacity to heal.

Future generations will benefit if this monk's views on the efficacy of various traditional treatments are kept on record.  His experience as a physician can also be similarly written.  Further, it will be useful to obtain photostats of the palm-leaf manuscripts in his possession.

RANASINGHE

To come back to the services of Attaragama Raja Maha Vihara, we may mention that students spent varying periods of study there.  Among the earliest of such students, one of the most brilliant was Mr. A.D.O. Ranasinghe, who first joined Attaragama classes when Venerable Hapuvija Siddhartha was the chief incumbent of the temple.  That monk had been a student under the chief physician to Sri Wickrama Rajasinghe, the last king of Kandy.

Venerable Siddhartha was succeeded by Venerable Tittavalle Piyaratana as head of the temple.  During the latter's term, the temple became widely known as a centre for the study of traditional medicine and also as a place where miraculous cures were effected.

After seven years of study at Attaragama, Mr. A.D.P. Ranasinghe went back to his hometown of Gampaha and set up practice there as a traditional physician, specializing in cauterization and vein puncture.  Popularly known as Watura Male Veda Mahatmayā, Ayurvedic Dr. Weerangule A.D.P. Ranasinghe was held in high esteem by his contemporaries.

He performed cauterization with a heated instrument.  The scope of his puncture treatment emphasized blood-letting by perforating veins at selected places.  That had been a technique adopted at Attaragama, too; this was confirmed by the present chief incumbent of the Raja Maha Vihara Temple at Attaragama, Venerable Golehenwatte Sumangala (age 71 years).  He readily volunteered to furnish details when Marga Institute officers visited him recently.  He hopes that a young monk from the temple, Venerable Asgiriye Sumanasara, will soon revive the study of traditional medicine there.  That young monk is now pursuing undergraduate studies at Kelaniya University.  With his university training he will be able to edit the palm-leaf manuscripts in the temple library.

Physician A.D.P. Ranasinghe's services are ably being continued by his son, Dr. S. Ranasinghe, L.A.M.S. (Calcutta), P.C.M.S. (Hong Kong).  His friends and relatives affectionately call him Sarath but his full name is Samarapala Ranasinghe.  He moved from his hometown of Gampaha and set up practice as a physician and acupuncturist at Kochchikade, 5.6 kilometres from Negombo on the Negombo-Chilaw road.

The area is thickly populated.  Sinhalese, Muslims, Bharatas, Jaffna Tamils, and Tamil-speaking people of Indian origin reside here.  Three grama sevakas (modern counterparts of earlier village headmen) serve in three divisions - Kochchikade proper, Pallansena South, and Pallansena North.  The majority of the residents are Roman Catholics.  The main occupations are fishing and making of tiles and bricks.  Coconut trees grow luxuriantly on either side of the road.  Unemployment is not a pressing problem here.  Kochchikade is also a centre of tourism.

Dr. Ranasinghe is popular in the area mainly on account of his educational background.  He was first taught at home by his father and later sent to Ananda College, Colombo, for his English education.  Still later he joined the College of Indigenous Medicine, Cotta Road, Borella.  For further education he went to India and studied Ayurveda at the Astanga Ayurveda Vidyalaya, Calcutta, where he obtained the Bhisagratna title and became a Licentiate in Ayurvedic Medicine and Surgery (L.A.M.S.).  His graduation certificate identifies him as the son of Ayurvedic Dr. A.D.P. Ranasinghe of Gampaha.

Among eminent scholars whom Dr. S. Ranasinghe associated with were Venerable Halgastota Devananda Thero, chief incumbent of the Vidyananda Pirivena, Pahalagama, Gampaha; Dr. R.B. Lenora, eminent physician of Colombo, who had the unique distinction of being academically qualified in western medicine as well as in Ayurveda; and Dr. Mohindra Lal Das Gupta, who was head of the Astanga Ayurveda Vidyalaya in Calcutta and a leading exponent of Indian Ayurvedic therapy.

On his father's instructions Dr. Ranasinghe toured India meeting traditional practitioners of repute.  Back in Sri Lanka, he set up practice independently.  In his leisure he wrote popular articles which were published in Rasavahini (journal of the Times Group) in April 1972, July 1974, and October 1974; in Pragathiya (journal of the China Friendship Association) in November 1975 and January 1976; and in the Ceylon Daily News of 25 July 1974, 12 April 1977, and 12 May 1977.  All these articles were short essays on various aspects of acupuncture, Chinese medicine, and traditional Sinhalese medicine.  In 1978 he went to Hong Kong and received training in Chinese acupuncture under Dr. Tan Kong, Dr. Ranasinghe mastered Chinese - both Cantonese and Mandarin - and also qualified as a Chinese acupuncturist.  He has 15 years of experience as a practising acupuncturist.

He has also delved into the Epigraphia Zeylanica and other records of ancient inscriptions and medical practices of the Sinhalese.  He has reason to believe that Sinhalese medicine developed independently and was not a mere copy of Indian Ayurveda.  Our traditional acupuncture and cauterization, our traditional treatment for snake bite, hydrophobia, and wounds from a mad-dog bite are unique.  Dr. Ranasinghe states further that there is ample evidence of advanced medical practice in the references made in four inscriptions:

• Kiri Bath Vehera Lipiya

• Mihintale Lipiya

• Kuturu Mahan Lipiya

• Madiligiri Lipiya

Two streams of medical thought seem to have converged in Dr. Ranasinghe - the ancient Sinhalese tradition and the modernized Chinese tradition.  They blend harmoniously in this young Sri Lanka physician.

He has been yearning to visit the Republic of China to see for himself the progress made there in acupuncture research.  This ambition of his has not yet been fulfilled.