M"EDICAL ESTABLISHMENT IN SRI LANKA DURINGTHE DUTCH PERTOD Q640.1t96)

K. D. PenarsevrrlNe

. . fl. earlier expeditions of the Dutch to the East took backwith them_1ot only rhe smell of fresh spice, bur "fr,

'if."":;i,ril",,Craze". The Dutch merchants in Amsterdam were anxious todeal in Indian goods for which there was much demand in Europe.Jlrerg wa_s an unprecedented rush among the Dutch peoplo 'tojLrin Eest Indian expeditions during the firsi few decades of the lTthcentury. They were mostiy d.riven by lure of wealth.

The United Dutch Erst India Company (VOC) which wasestablished in Amsterdam in 1602, considlered that ii was its dutyto look after the hearth of its employees.r wirh thar objectivethe chamberAmsterdam added to rts caare three posts ofmedicarprofessionals, namely, an apothecary, a doctor and a surgeon. fn1602, there was an apothe"ury io A-ri".dam who supplied medicinal:.hrrj:.t_" ships leaving for rhe Easr.2 During the period 1602_t632the Middelburg Chamber employed I 14 surgeons and 3 doctors.

In the 17th century a university degree was not essential tobecome a surgeon. Therefore, urry oftJn it was considered thata surgeon belonged to a little lower grade than a doctor.Experience was more important than a deg.e" to become u ,urg."n.Another task of these two was to carry iut research together onvarious diseases. It was also their duty to see that correct instru_nents were supplied to the ships, surgeons who were leaviog iorthe East.

"Itr the lTth and lgth centuries the germ theory of diseaseand cellular structure of the body *.r. ,till unknown. t;r;i;the importance' of such scientific landmarks as the dir"o;;d;ithe circulation of brood by william Harvey and that of red

104 I{EDICAL ESTABT,ISHMTNT IN SRI LANKA .:OLIRNAL R. A. S. OF SRr LANKA l/ol. xxxilI(N..S.) l988i89 105

The policy for administration of hospitals in the island waslaid down by the Dutch Political Council in Colombo, the seataf their government. A few years after the Dutch capturedColombo from the Portuguese, in or around 1661, a city councilrvas appointed to look after the interests of their compatric,ts inColombo. It was recorded for the ilrst time in 1666 that tire seniorsurgeon Michiel Dibbe was appointed as the surgeon in Colomborvith two assistants.s He was a member of the Colombo citycouncil too.

The fi.rst document that I came across in this connectionamong the Dutch records in the National Archives was a set ofinstructions issued to regularise the functions of the stewardsof the (Schaffbass) Dutch Hospital in Colornbo. dated 01.02.1669,in which it is stated that :'It has been considered that it is a dutyof the Company to restore the health of its officers who are onboard ships as well as in the outposts,'.

ln a memorandum to the Political Council, the chief surgeonaf the Colombo hospital, Jacobus de La Haije stated ,, that(Company's) invalid officers could be brought back to theirformer state of health with the blessings of the God only by wayof good care and attention. Therefore it is necessary to issueclear instructions to senior surgeons who are in the service of theCompany in this country to perform their duties deligently'".2

Decisions on medical establishment were very often based

'-rn submissions made by the chief surgeon in Colombo hospital,rvho was considered to be the best qualified and experienced personior such submissions.

In August, 1788 the Dutch political Council in Colombodiscussed extensively the medical establishment in the counrry.According to these minutes it is ciear that the medical service waswell establishedin the countrybythe second half ofthe lgth century.The chief surgeon who had the longest service in the Colombohospital, Barend Alleman (1756 - l79l) submittecl his observationsto the Political council orr the entire set-up of the medical establish-nrent in the conntry.s

blood corpuscules and spermatozoa by the Dutsh microscopist

Anthony van Leeuwenhoek, medical diagnosis and treatment were

still largely influenced by the traditional Greco-Roman humoral

pathology, which considered all diseases as an imbalance or an

irnpurity of the four bodily "huinours'n or fluids. Treatment

aimed at readjusting the balance predominantly by the use of

enemas, purging, bleeding, and dieting but also by the employment

of stimulants, tonics and drugs'"3

The Duteh East India Company had to meet the increasing

demand for hospitals in tireir newly acpuired territories' One

reason for this demand was that ships arriving from Europe had

a considerable number of sick persons on board' Sailors who

left Holland in search of wealth had to undergo many hardships on

their way to the East' They sufferecl by being confined on board'

eating stale food and undergoing surlden changes of the tropical

climatic conditions during their months long voyage'

The Cape of Good Hope which was once called the 'oTav€rn

of the Inclian Ocean" (hdisihe Zeeherberg ) lvas the best resting

place for seamen on their way from Europe' The crews ol lhe

butch lndiameu gencrally suffered lrom scurvy and other ship-

board d.iseases. In 1782, for example, ten Indiamen from the

fatherland carrying 2653 men suffered heavy casualties and--1095

or 43/, of thim clied before reaching the Cape of Good Hope'

wnile b15 survivors were admitted to hospital' Such was the

situation mid-way to Colombo-

The next major and comfortable port of call for the seafaring

Dutch population was Coiombo. The sailors who landed in

Colombo were in need of pure air, green vegetables and fresh rneat'

Thcse contributed more to their recovery than a doctor with his

medicines. Probably the increasing mortality and morbidity

on board during the second half of the l8th century-were due to

the chronic ill - health of so many of the men who embarked

ships. The Dutch authorities in Colombo were cornpelled

provide a sufficiently large hospital in Colombo and the outpos

in Sri Lanka, according to the strength of the garrison and tlEuropean communitY.

106 IVIEDICAL ESTABLISHMENT IN SRI LANKA -:,OURNAL R. A. $. oF' sRI LANKA Vol. XXXilI (N..t.) 1988189 t07

According to his report there were 8 hospitals administeredby the Dutch authorities in Ceylon namely; Colombo, Jaffna,Galle, Trincomalee, Matara, Kalpitiya, Batticaloa, Mannar andthe South Indian town Tuticorin.

According to. circurnstances generally a good beef soup anda dessert were given to the patients in all hospitals. The patientswho were not suffering from serlere diseases were given vegetableand fish. Seriously ill patients were served with gruel, milk,chicken, soup, sago and sometimes fruits or bread on prescription.

In the Colombo hospital about 300 men could have been

accommodated, whereas the capacity in Jaffna and Galle was about100 - 150, and in Trincomalee 60 - 80.

Except for trusses nothing was given free to the patients.

Almost all the patients treated in hopitals were service personnel

and the Company deducted half their salary as hospital dues for theperiod they stayed in hospital. According to the requirements ofthe patient, linen, a pillow and a mattress were supplied for thisamount. It was recommended in 1788 that patients be given one

rupee per month to enable them to purchase sugar, tea, coffee,

tobacco etc. This money was also deducted from their salary.

The medicines imported from Europe were stored in chests

in the Company"s warehouses. No cine was allowed to openthe chests without the knowledge of the doctor who kept the keys

with him. Even if the apothecary needed some medicine he hadto go to the warehouse with the doctor to open the chests andfetch his requirements. The stock in hand and the amountconsumed were carefully entered in the books provided for thepurpose.

All medicines were dispensed according to a pharmacopoeiaapproved by the Political Council and listed in its entirety in the

Political Council minutes of 1757.e This pharmacopoeia was

in use throughout thesecondhalfofthe l8th century. It shouldbe rnentioned here that this pharmacopoeia was in conformitywith similar contemporary works adopted in London, Berlirand Edinburgh.

Some of the local drugs which supplemented western medicinesrvere gall-nut (aralu, S.), Gentiana chirata (bin-kohomba, S.),

Citrus Aurantium (ernbul-dodan, S.), pepper, clove, aloe (komarika,S. ), cinnamon, Cassia auriculata (ranau,ara,S. ), nutmeg, tamarindnnd Piper longunr (tippili, S.).

Cinnanlon, which was a spice exblusive to Sri Lanka, pepper

well known as an aromatic condiment and corriander which is

a diaphoretic in Ayurvedic medicine figured often in the D:-rtchpharmacopoeia.

Wine was generally considered a panacea for a number ofminor diseases. Different varieties of wine were supplied forruse in the hospital bacause of their balmic qualities. It was

considered a tonic for patients languishing frorn loose motions'Those who had weakened entrails could easily bear up with the

Capered winebecause of the acidity found in it. Liquor, includ-ing arrack, was given to patients under certain circumstances.Opium too was used as a common drug and rvas imported fromSuraf one of the Dutch possessions in India.

The Dutch studied the medicinal value of local herbs rightfrom the commencement of their administration in Sri Lanka.Dr. Faul Hermann, the surgeon who was described as "The Fatherof Botany" in Sri Lanka and who later was appointed to the chairof medicine (16S0) at Lieden University, served in the ColomboHospital from 1672 to 1679 and took more interest in botany thanin surgery.ll He collected local plants and sent them to Leiden.The herbarium iollected by Hermann during his stay in Sri Lankarvas brought to light about 70 years after his death when itsclassification was published under the title 'oFlora Zeylanica"by Carolus Linnaeus (t707 - 1778.|z

A contemporary writer Francois Valentijn (1666 - 1727\while referring to native medicine said that, "among them chickenpox and fever prevail strongly, from which each must protectand heal himself, as there are no doctors or surgeons here, soeach one prescribes rough remedies, for hirnseif generally havingtn the house veiy good ointments and wholesome oils which healaknost anything. Also they make some emetic and purging

108 il{5I)ICAL ES'TABLISI{MENT IN SRI LANKA

drinks for which tirey are able to choose certain leaves and barks oftrees which are very useful, and also a certain thorny tree and someobking berries. There are few diseases for which they know noremedy even to the extent of completely curing sorneone who ispoisoned or is bitten by a poisonous creature, though this happensseld.orn without their being taken over by this or that magician.

"They have berries in this land from which they know howto make an ointment with which they can cure a broken leg andset it well again in a ferv hours."l3

The Dutch, in fact, appreciated the superior knoweldge ofherbal nredicines possessed by ayurved.a physicians. They madeuse of this knowledge. A far reaching resolution was adopted inthe Political Council in 1793 by which provision was made toappoint "native" physicians to each of the Dutch hospitals in theisland. The Dutch acts of appointments of the Colombo Secre-tariat recorded three such appointments even shortly before 1793.Zareek Lebbe in l79l,ta Mira Lebbe Meestriar seka Marikkar inl7glts and Jenedien Thambie Kandoe in 1792t6 were appointed"physicians". These three were named as physicians while the restwere referred to as doctors or surgeons. The word 'physician' mayhave been used because they werJ natives. Their duiy was to assistthe chief surgeon during his daily visits to the sick in such a waythat their knowledge could be used by him in the best manner.

" Europeans stationed in Sri Lanka were badly affected by

several tropical diseases which prevailed in the country. Theysuffered frorn them more than the local inhabitants due to lackof sufficient immunity. The garrisons outside Colombo werereported to have dysentery and diarrhoea in epidcmic proportions.I'hey were brought to the closest hospital for more careful treat-ment. Malaria too was au acute problem outside Colombo. TheDutch had taken timely action against leprosy an<1 established aseparate hospital in Hendala in 1708.17

The Dutch paid special attention to the problem of curingpatients with veneral diseases (onreine zieklen). ChristopherSchweitzer saw many soldiers in Colombo hospital "who inpursuit of their lustful desires destroy themselves by venerealdistempers".ls

louRNAL R. A. S. OF SRI LANKA Vol. XXXUI(N..S.) t98g/S9 109

The pay-rnent of a gratuity to the surgeon who successfullytreated pa.tients rvith so called "dirty diseases" was approved bya Folitical Council resolution in 1788. The resolution statesthat the doctors and surgeons in Sri Lanka were not benefitedby the resolution on gratuity passed by the High Government inBatavia. Therefore the Council approved that the superintendentsof Colombo, Galle ancl Trincomalee be paid a gratuity. It wasfixed at Rds. 200 for Colombo and R.ds. 100 each to Galle andTrincomalee.le

In conclusion, it is appropriate to quote Johan WolfgangI{eydt, a German write.r, who was in the Company's service inCeylon, about the reputation of the medical establishment inthe island: "I have already mentioned in nry earlier pages concerrl-ing Batavia the bad arrangements of the hospital there but herethe conditions are very different. I think the Company has nobetter hospital in all the Indies than in Colombo. Since herevarious and costly medcines are prepared, and there is a doctorto be found provided with a good laboratory together withtwo, three assistants who are experienced in medicines".20 Althoughthis statement refers only to the Colombo hospital it is relevantto other hospitals in the lsland since it was a model for them ton.

NOTES

1. Pieter Van Dam, Ileschrijving Van cle Oostinclische Compagnie,Eerste Boek, Deel IV Dr. F. W. Stapel, 's-Gravenhage. 192?. ppr.

607 - 619.

2. F. M. Wieringa, De YOC in Amsterdam verslg van een *erkgroep,University of Amsterdam, 1982, p. 105.

3. C. R. Boxer, The Dutch seaborne Enryire 16A0 - 1800, London, 1965p. 178

;{. Op. cit. p. 243

5. Sri Lanka National Archives. Dntch Pr;liticcrl Council Minutes. 1(,66-05-09, SLNA 1i12.

6. SLNA, t/1453

7 SLNA, 1118, p. 49-52.

ll0 MEDICAI- E5TABLISH&IENT IN SRI LANKA

8. SLNA, 1/202, 1788-08-02.

9. SLNA, 1/180, 1780-06-20.

10. SLNA, 1/180, 1780-06-20.

11. Rt. Rev. Dr. Edmund Peiris, Paul Hermantt the Father of CeylonBotany, JRAS (CB), (N^S) I/e,/. II, 1952, pp. l-20.

12. Rt. Rev. Dr. Eclmund Peiris, OMI Srudies in Medical Herbaria duringtlte Portuguese and the Dutch times in Sri Lanka, Transactions of theCeylon College of Physicians, Vol. 6, No. I, 1973, pp. 97-L08.

13. Francois Valentijn Desuiption of Ceylon, Translated and Edited by

. Dr. S. Arasaratnam, The Hakhryt Society, London, 1978, p. 168.

14. SLNA, 112548, p. 266.

15. SLNA, 1i2s48, p.266.

16. SLNA, 112549, p.4:.

17. C. de. F. W. .Goonaratn a, Sonrc l{istorical. Aspects of Leptrosy in Ce,vlonburing the Dutch Period, 1658 * 1796, Medical History, 1971, Vol. 15,pp. 68 - 78 and Medical History, 1973 Vol. 17, pp. 308 - 315.

18. R. Raven - Hart, Germans in Dutch Ceylon Tbe National Museumsof Ceylon - Translations Series. Vol. I. (No date) p.49.

SLN.A,, r1202, l788-08-07"

Johann Wolfgang Heydt, Heydt's Ceylon Translated by R. Raven Hart,Colombo. Ceylon Government Inloraation Department, Colombo,1952. p.3.

r9.

20.