Ayurveda, malaria and the indigenous herbal tradition in Sri Lanka

0277-9536/91 $3.00 + 0.00 Copyright 0 1991 Pergamon Press plc

Sot. Sci. Med. Vol. 33, No. 2, pp. 153460, 1991 Printed in Great Britain. All rights reserved

AYURVEDA,

MALARIA AND THE INDIGENOUS TRADITION IN SRI LANKA KALINGA

HERBAL

TUDORSILVA

Department of !Zociology, University of Peradcniya. Peradcniya, Sri Lanka Abstract-Using key informants and available records, the way in which inhabitants of purana villages in Nuwarakalaviya, Sri Lanka coped with malaria during the pre-DDT era is examined. Thii study found that the Nuwarakalaviya peasants responded to endemic malaria through a localized herbal tradition, which was to some extent independent of the scholarly ayurveda system common to the whole of South Asia. The relevant herbal tradition, consisting of a combination of antiparasite and antive-ctorstrategies using locally available natural resources, represented an effective adaptation to the local ecosystem.

Key words-ayurveda, malaria, folk medicine, Sri Lanka, South Asia

This paper examines how peasants in a malariaendemic region in the dry zone of Sri Lanka perceived

and dealt with malaria prior to the introduction of western scientific ideas concerning the disease and its control. In view of the recent resurgence of malaria in many parts of the world and the absence of any imminent technological breakthroughs that may enable the affected tropical countries to overcome the disease in the near future, considerable attention has been focused on the re-examination of the efficacy of indigenous herbal remedies and the effect of certain cultural practices like nomadism, clothing habits etc., as related to malaria [l-5]. These studies found that the relevant herbal remedies and the cultural practices often constitute an effective adaptation on the part of humans to endemic malaria. While sharing the general theoretical orientation of these studies, the present essay does not aim at assessing the efficacy, medicinal properties or contemporary applicability of the relevant indigenous ideas and practices. Rather it examines the ways in which the local peasants historically perceived and responded to malaria and how it related to their ecological and cultural milieu. More specifically, it explores the relationship between the relevant herbal tradition and ayurveda, which is generally viewed as the system of indigenous medicine common to the South Asian Region. In anthropological accounts of folk health beliefs and practices in South Asia, primary attention has thus far been paid to the influences of the ayurvcda system and its interaction with western biomedical concepts [6-121. This is not surprising given the fact that ayurveda is part of the great tradition in the whole of South Asia [13]. It is, however, important to remember that often the scholarly ideas of ayurveda affected folk thinking and behaviour through diverse indigenous herbal traditions, which, in turn, were part of the little traditions representing various geosubcultural units within South Asia. Among the Sinhalese in contemporary Sri Lanka terms such as athbehefh (medicine-at-hand), goduzedukuma (local therapies) and parampara vedakama (ancestral medicine) are sometimes used to distinguish what remains

of the indigenous herbal tradition from pure ayurveda (nyuruedaya) of North Indian origin [14]. Other widely used contemporary teRns, like sinhula vealzkama (Sinhalese medicine) and deshiya vedakama (indigenous medicine) refer to formal ayurveda, the localized herbal tradition or a mixture of the two depending on the context. As malaria is primarily an endemic focal disease affected directly by the ecosystem of a given area, the localized indigenous herbal traditions can be expected to play a more important role in shaping the local people’s perception of and responses to this disease [l-3, s]. The data reported here were obtained as part of the Sarvodaya Malaria Control Research Project (SMCRP) aiming to develop a primary care approach to malaria control. Among other things the SMCRP sought to identify and evaluate suitable indigenous practices [15]. The methodology used for data collection consisted mainly of indepth interviews with selected indigenous practitioners and elderly lay informants who were knowledgeable about customary local practices related to the disease dating back to the pm-DDT era. Some relevant secondary sources, including indigenous medical texts and reports by colonial administrators, were also consulted. Finally, the data were checked with a few ayurveda scholars, a malariologist and a medical entomologist. THE STUDY AREA The SMCRP study area lies in the eastern part of the Anuradhapura District, formerly known as Nuwarakalaviya. Covering about 80 km2, it consists of aonroximatelv 17.500 oeonle distributed in some 60 Gilages. Bouhded by ;oa& linking Kekirawa in the South. Galkulama in the North and Yakalla in the East, ii forms a triangular area lying to the South East of the ancient city of Anuradhapura. The terrain, which is flat, is drained by Malwatu Oya and its tributaries. This being a dry zone region, the annual rainfall of about 1250 mm is largely concentrated in the period from November to January, with possible secondary rains around May each year. Due to the above rainfall pattern an elaborate irrigation system 153

154

tiLINGA

TUDOR

had been evolved so as to ensure cultivation of paddy, the staple food of the local Sinhalese. The study area had been in the centre of an ancient hydraulic civilization, which reached its peak around the 12th century A.D. This civilization subsequently collapsed due to foreign invasions and a variety of other historical circumstances that cannot be spelled out here, and a form of nucleated human settlements gradually evolved in the midst of the ruins and a thick forest cover. The efforts of successive colonial and post colonial regimes to redevelop the dry zone through irrigation and resettlement schemes have not yet affected the study area. Hence, it remains a useful setting for the study of folk beliefs and practices indigenous to Nuwarakalaviya. The village communities in this part of Sri Lanka are known as purana (ancient) villages, signifying their continuity over a long period of time. Relative to comparable rural communities in the wet zone of Sri Lanka the purana villages remain sparsely populated with a mean population size of 300 in 1986, despite reports by some observers that there has been a marked population growth in purana villages in more recent years [la]. The communities are widely scattered; each community is surrounded by a stretch of jungle used by local peasants for a form of slash and bum cultivation known as chena farming, which together with rice cultivation constitute the main elements of the subsistence economy of the purana villages. For the purpose of conserving water for rice cultivation each village has one or more communally maintained local reservoirs (tanks) sustained over a long period of time. As for social organization, each village is a single caste entity internally unified through kinship bonds; for the most part interaction across villages traditionally took the form of formalized exchanges of goods and services between those of different castes. In his classic study of a village in Nuwarakalaviya Leach found that the local ecosystem inclusive of manmade irrigation works largely determined the nature of social organization in a purana village and its relative stability [ 11. The area under study is hyperendemic for malaria. As elsewhere in Sri Lanka the commoner plasmodium species found here is P. viva-x with P. falciparum as the secondary, but more virulent species. R. culicifacies, the known vector for malaria in Sri Lanka, breeds in a variety of local habitats 1151. Table 1 shows recent malaria trends in the Kekirawa Malaria Control Region which, with an estimated total population of 225,000 as of 1986, includes the study area. As evident from Table 1, there is a marked fluctuation in malaria incidence in the region from year to year. In the high year of 1986, about 26% of the total

SILVA

population of the region were found to be microscopically positive for malaria with P. vivax and P. falciparutn (including mixed) infections accounting for 84.5 and 15.5 percent of the total incidence respectively. Figure 1 shows that while there is continuous malaria transmission in this region throughout the year, there is a marked annual peak in malaria incidence from October to December which in turn corresponds with the peak rainfall season. It has been found that heavy monsoonal rains commencing in October result in a proliferation of temporary ground pools leading to a marked seasonal upsurge in vector breeding in the months that follow [lS]. On the other hand, the natural streams and irrigation systems maintain a moderate level of vector breeding and a resulting continuation of malaria transmission throughout the rest of the year, thus giving rise to a never-ending cycle of endemic malaria. The government health facilities in and around the study area are of a rudimentary nature. There is a variety of ‘traditional’ practitioners, including herbalists in general practice (saroungaveda), snake-bite specialists (&me&), bone setters (handiueda), and a handful of college-trained ayurvedics (veubmhattayo or doctor). Unlike college-trained ayurvedics who possess formal medical qualifications acquired from one or the other of the ayurveda colleges in the country, the first three categories of practitioners commonly practise purampora vedakama (ancestral medicine) typically transmitted from father to son. Often the parampara vedas proudly possess inherited collections of ola-leaf manuscripts containing secret medical prescriptions. The parampara vedas may or may not possess a sophisticated knowledge of the ‘humoural theory’ (t&or vadoyn) of ayurveda. While college-trained ayurvedics often prescribe westem medicine sometimes in combination with ayurveda preparations [ 18-191, the parampara vedas generally do not utilize any western medicine in their practice. While the parampara vedas claim that only they practice genuine sinhalu vedakumu, the ayurevedics see themselves as more scientific and more broad-minded compared to parampara vedas. On the average a local purana village has 3 to 4 parampara vedas. The college-trained ayuredics, who

Legend

18,OCG 16,000

t

- - -

Malaria incidence Rainfall

14poo

250

200

l&~

5

14~

150

5 e C

100

p

6000

Table 1. Malaria Trends in the Kekirawa Control Region 1983 to 1986

p

6000

Malaria species Y.Sr

No. of blood smears

Pv

ff or mixed

Total positivts

SPR

1983 1984 1985 1986

26,018 26,617 40,939 97,829

4197 10,535 7270 49,491

167 120 602 9050

4364 10,655 7872 58,541

16.8 39.9 19.2 39.8

,.

0

0 JFMAMJJASONO

1986

Fig. 1. Monthly variation in Malaria incidence and its

. ..-. _~ --!_I-,. ~,_,.I______ __,__z____*.._,__A__ ICI*‘

Ayurveda, malaria and the indigenous herbal ttadition

are often not from the local area itself, typically operate from small towns in the area. Before we examine the local folk beliefs and practices related to malaria, it is useful to.consider the relevant historical context. HISTORICAL

BACKGROUND

Malaria has been a leading cause of morbidity and mortality in the Anuradhapura District throughout its known history. Its possible role in the fall of the ancient hydraulic civilization of the dry zone is subject to speculation and will not be considered here [20]. The early colonial literature is replete with references to ‘agues and fevers’ prevailing in various parts of Sri Lanka [21-261. After 1860 the term ‘malaria’ gradually became established in official records. Robert Knox, one of several Englishmen in captivity in the Kandyan Kingdom from 1660 to 1679, had several attacks of agues and fevers during his efforts to locate an escape route to the Dutch territory through the wilderness of northern Sri Lanka inclusive of Nuwarakalaviya [21]. He observed “The Diseases this land is most subject to, are Agues and Feavours (sic.)” and further referred to it as the “Countrey Sickness”. In this manner we went into these Northern Part eight or ten times . . . . For these Northern Countrey being much

subject to dry weather, and having no springs, we w&e fain to drink of Ponds of Rain water. . . . This did not axree with our Bodies, being used to drink pure Spring water%nly. By which means when we first used these parts we used often to be sick of violent Feavours and Agues, when we came home. Which Diseases happened not only to us, but to all other People that dwell upon the Mountains, as we did, whensoever they went down into those places; and commonly the major part of those that fall sick dyes. At which the Chingulays are so scared, that it is very seldom they do adventure their Bodies down thither.. . . Our Countreymen and Neighbours used to ask us, if we went thither purposing to destroy ourselves. . . . At length we learned an Antidote and Counter-Poyson against the filthy venomous water, which so operated by the blessing of God, after the use there of we had no more Sickness. It is only a dry leaf; they call it in Portuguese Banga, beaten to Powder with some of the Countrey Jaggory; and this we eat Morning and Evening upon an empty Stomach. It intoxicates the Brain, and makes one giddy, without any other operation either by Stool or Vomit [21].

From the account of Robert Knox it is clear that the 17th century inhabitants of Kandyan Hills, among whom Knox was living, took care not to visit the northern plains in order to protect themselves against what was then understood as agues and fevers. It is not clear whether his theory linking the disease to the drinking of filthy venomous water of the dry zone was influenced by any prevailing indigenous ideas. The antidote referred to may be cannabis, and probably the practice of using it as a prophylaxis against malaria was introduced to the country by the Portugese [22]. Malaria conditions in Sri Lanka evoked many responses from successive colonial powers. Often the early European commentators attributed it to “foul air from the marshes” following the western tradition. Others attributed it to environmental or

155

behavioural causes, such as sudden changes in atmospheric temperature, environmental pollution, imprudent exposure to tropical sun and intemperance [22-261. These ideas only slowly disappeared following the modem scientific discoveries during 1880 to 1900 concerning the mode of transmission of malaria. From a much publicized debate instigated by Sir Henry Blake, the governor of Ceylon in 1905, it is evident that the colonial administrators were also curious about the indigenous health beliefs. In his address to the Ceylon Branch of the Royal Asiatic Society in 1905 Blake reported that some old ayurvedic texts brought to his notice by a certain Native Medical Association of Mutwal postulate a connection between malaria and mosquitoes long before the role of mosquito in the transmission of malaria was discovered by Manson and Ross (221. However, a thorough re-examination of the relevant medical texts revealed that the passage in question possibly refers to some other complications attributed to insect bites. Further certain colonial administrators sought to identify and determine the efficacy of indigenous herbal remedies for agues and fevers. For instance, Ondatjie, who was the Assistant Colonial Surgeon in Uva, reported in 1861 that after extensive studies he found the local herb dummella (Trichosanthes cucumerina) to be an effective medicine for fever, containing one of the active ingredients of the cinchona bark [24]. Apparently the British raj had identified and sought solutions for three separate problems of malaria control as related to Ceylon. First, there was the problem of malaria control among the British and other European residents in Ceylon, including the colonial administrative staff, planters and military troops. By virtue of their background they were highly susceptible to malaria. Further, it is likely that the British gave highest priority to overcoming their own malarial problem. It appears that whenever possible the European residents avoided visiting endemic areas as a precaution against malaria (23-251. Where they did venture out into or were posted in endemic regions it was customary for them to selfmedicate with quinine as a prophylaxis or cure [23]. Cinchona bark was first introduced to Ceylon during the 16th century by Jesuit missionaries who used it to treat fever [22]. In 1860 Moss advised against indiscriminate use of quinine by British residents in Ceylon and recommended two or three grains with the morning coffee only when visiting a malarial district [23]. Finally, the provincial administrators resident in malaria-endemic regions were permitted to move out to safer places temporarily during the peak season of malaria transmission in each year as stated in the following passage. Situated in a vast plain which is covered with dense wood, and in which there is a multitude of neglected tanks, the place (i.e. Nuwarakalaviya) is certainly no sanitarium, but still I think that during nine months of the year it is fully as healthy as most stations. The unhealthy season lasts from the beginning of December till the end of February, and during this portion of the year the establishments are allowed to remove elsewhere. As the jungle round the station becomes cleared away, and as the place becomes

156

KALINGATUDOR SILVA

more healthy, there will probably be no occasion for an annual interruption of public business [25].

FOLK TEEMS, PERCEPTIONSOF ILLNESS AND SYMF+TOMOLOGlES

Thus even before the mode of transmission of malaria and its relation to weather conditions were established scientifically, the British residents in Sri Lanka had clearly and correctly identified the seasonal pattern of malaria transmission and had devised an effective way of escaping its worst consequences on themselves. Secondly, the British, specially planters, were concerned about the health of the plantation labourers who were of Indian origin. By virtue of their location in wet zone hilly areas, plantations were relatively free of endemic malaria. However, the estate workers were exposed to malaria during their long and arduous journey from India to Sri Lanka as well as during their annual pilgrimage to Kataragama located in the dry zone. From the early days the planters had noted that annually the work in the plantations was diswho returned from rupted, as the labourers Kataragama became ill with what was referred to as “Kataragama Fever” [27]. Later the government malariologist found that the so-called Kataragama fever was indeed malaria. The steps taken to control malaria among the plantation workers will not be discussed here as it is outside the scope of the present study. Last but not the least, the British raj had to address the problem of malaria among the native inhabitants, especially in the endemic areas. Apart from humanistic and welfare considerations, the British were well aware of the constraints to dry zone development and revenue collection arising from endemic malaria. However, it is clear that of the three categories of malaria victims, natives received least attention in the malaria control efforts of the colonial regime. The Government Agents for Nuwarakalaviya repeatedly noted in their annual reports and diaries the unhealthy condition prevailing in the district due to widespread prevalence of fever, cholera and parungi (yaws). Of these parungi and cholera were seen as diseases newly introduced to the local population by the Portuguese colonizers and Indian estate coolies passing through the area respectively [28]. Malaria fever, however, was clearly recognized to be indigenous to the area as implied by the local “Fever of Nuwarakalaviya” [25]. Ivers described it as the “disease par excellence” of the district [26]. Although the government Anti-malaria Campaign started in 1911 and became a national programme in 1925, its distribution of quinine in parts of Nuwarakalaviya was only sporadic until the great epidemic of 1934/X [29]. During the great epidemic several malaria control and relief measures, including distribution of quinine, oiling or draining of pools and swamps and clearing of jungle where necessary were carried out by the government in local villages through health services as well as through civil administration. Regular indoor spraying of DDT began in this area after 1945. In this context it is pertinent to ask how peasants in this remote malaria-endemic region perceived and dealt with the disease before they became affected by modem scientific ideas and control measures relevant to the disease.

Although the term malaria had been used by some officials since the latter part of the 19th century, it was translated into a widespread folk category (maleriyawu) in Nuwarakalaviya much later, probably during the great epidemic of 1934/X The folk tradition in Nuwarakalaviya recognized many febrile conditions, including unahembirissuwu (fever and cold), unukuhihembirissuwu (fever, cough and cold) guhenu unu (shivering fever), kufa MU (jungle fever), mura unu (fever that recurs at fixed intervals), unasannipuruyu (fever caused by upsetting of three humours), sunniyu (chill, coma), koleguyu (chest pain) and wuhppuwu (fits). As is usually the case with folk illness categories (91, it is rather hazardous to attempt a translation of the above terms into western disease categories as defined today. Of the different febrile conditions, unahembirii.~uwu was considered the least serious and wufippuwu the most serious. As was also reported for South India, it was generally held that if not treated properly less serious conditions would rapidly deteriorate into more serious ones [30]. Most probably unuhembirissuwu and unukuhihembirissuwu referred to different states of common cold. In Nuwarakalaviya the terms guhenu unu, kulu MU and mura unu were used more or less synonymously, and it appears likely that mostly, if not exclusively, they referred to malarial conditions. It is significant that fever (una) is mentioned in all three terms. As accompanying symptoms, guhenu unu refers to shivering and muru unu refers to periodicity of fever. The term kulu unu (jungle fever) probably postulates an association between malarial fever and chena cultivation in the jungle, which throughout the dry zone normally coincides with the peak season of malaria transmission in a year. Of the remaining febrile conditions identified in the local folk tradition, unasunniputayu was considered an acute condition caused by the simultaneous upsetting of all three humours. Sunni-kola-wullipu in turn were seen as further complications arising from unusanniputuyu. In addition, physiological and mental derangements of a specific nature, such as unuvikaru (deliriums), were commonly attributed to sunni-kolu-wulippu. Some indigenous medical texts mention 18 types of sunni, 18 types of kolu and 18 types of wulippu giving this illness complex an omnibus character (311. It may well be that several unrelated western disease categories, such as pneumonia, typhoid, encephalitis, or even acute cases of falciparum malaria were included within the sunnikola - wulippu complex. In Nuwarakalaviya it was widely known that there was a sharp seasonal increase in the incidence of fever during certain months of the year. Over the years the local people had come to recognize an association between the fever season and certain cyclical changes in their environment. The people used to say “Fever breaks out when the flowers of the thoru plant begin to appear”. This ubiquitous local plant (Cassiu tore) flowered annually following the onset of monsoon rains, the peak season of malaria transmission in the area [32]. Whether or not and in what way the thoru

Ayurveda, malaria and the indigenous herbal tradition plant was implicated in any folk etiology of the disease is not clear from the present-day accounts of past perceptions. In folk symptomology malaria fever (guhena una) was necessarily associated with agues. A folk phrase widely used to describe malarial fever was “shivering and vibrating like the coconut flower” (polmala wage sum sofa gala gahenawu). The analogy of the coconut flower possibly referred to the rhythmic whipping of one’s forehead with a coconut flower and the accompanying bodily movements by a possessed healer during some local rituals. Thus it is significant that the folk perception of the disease was much influenced by environmental and cultural markers specific to the local area. At this point it is important to consider what role ayurveda and related metamedical ideas played in the folk beliefs and practices relating to malaria in Nuwarakalaviya. It appears that, with the exception of a few college-trained ayurvedics practicing in the area, neither the local herbalists nor the lay peasants were familiar with the ayurvedic terminology commonly applied to malaria, namely uisamujwuru (intermittent fever) and santulajwuru (remittent fever) and the relevant treatment formulae [33]. Even the few local practitioners who had a knowledge of relevant ayurveda ideas and practices did not use them widely in the diagnosis and treatment of any of the locally prevalent disease conditions. The only ayurveda term encountered in the local illness terminology is sunnipatu, referring to upsetting of the three humours. However, it appears that the ayurvedic humoural theory of disease causation did not play any significant part in the local perception of malaria. On the other hand, the ideas, practices and even the terminology used in the local sunni-kolu-wulippu illness complex have been commonly attributed to the South Indian Siddha tradition [31]. Accordingly, to the extent the scholarly ayurveda system impacted the folk concept of malaria and possibly other local illnesses, it seems to have done so indirectly through the popular Siddha tradition. The available evidence does not indicate that there was any unified and universally valid perception of malaria throughout Ceylon during precolonial and early colonial periods. It is possible that malarial conditions were known by different terms in different malaria-endemic areas in Sri Lanka. Perhaps this explains why early European writers identified fevers by the names of the respective regions, i.e., Fever of Nuwarakalaviya, Kataragama Fever, Wanni Disease, etc. This view is also supported by contemporary ethnographic research in another part of Sri Lanka r341.

FOLK REMEDIES AND JITHNOPHARMACOPOEU

A basic home remedy widely used in Nuwarakalaviya villages as a first level of treatment for unakahihembirissawa (fever, cough and cold) was a preparation made from ginger and coriander (ingurukotrumafli). Until recently more serious febrile conditions including suspected malarial fevers (i.e. muru una etc.) were locally treated with a specific herbal preparation called pastel tumbuma (lit. brew made from five types of oil). This preparation in fact was made by adding five types of vegetable or animal oils to a brew made from five types of local herbs as given in Table 2. Its method of preparation consisted of pounding all five herbs together in a mortar, steam-boiling the preparation using an indigenous device (oanduwa), squeezing its essences (swurasaya) and finally adding the required quantities of the five types of oils. The preparation was consumed two or three times each day together with one of the local sweeteners-bee honey of jaggery. Being a popular home remedy and an athbeheth (medicine-at-hand), the ingredients ofpasrel tambuma and its method of preparation were widely known among the local peasants. One important feature of this preparation was that all its ingredients were readily available and indigenous to the local area. All of the five herbs used were to be found in one’s own home garden or its immediate surroundings. Four of the oils used were extracted from the seeds of commonly found local plants. Of these sesame was (and still is) an important food crop grown in the local chenas. Moreover, the techniques of extracting oils from the relevant seeds, using a locally made wooden crusher and an accompanying mat container (paha), had been known in this area for generations. As raising of cattle too is an important ingredient of the rural economy of Nuwarakalaviya, ghee is also readily available. Finally, of the sweeteners used with pastel tambuma, bee honey was readily collected from the local jungle in some months of the year. On the whole, pastel tambuma preparation was firmly rooted in the local ethnopharmacopoeia. In contrast to ayurvedic preparations called ‘kashaya’ (decoction), also typically containing numerous exotic substances such as dried grapes, dates etc., the tambuma preparations belonging to the indigenous herbal traditions almost always utilized locally available substances. The local parampara vedas as well as the elderly key informants admitted that in the past pastel tambuma was widely used as a home remedy for malaria in the local area and claimed that it gradually fell into disuse following the intro-

Table 2. Components of pastel tambuma Oils I.

Kohomba tel (oil extracted from the seeds of the plant Azadirachta Mica) 2. Tala tel (oil extracted from the seeds of the plant Sesumum indica) 3. Mce tel (oil extracted from the seeds of the plant Madhuca longtfilia) 4. Erandu tcl (oil extracted from the seeds of the plant Ricintu commmic) 5. Gital (nhcc1

157

Herbs 1. Yakinaran leaves 2.

(AtlanticI ceylanica) Lime leaves (Citrus atrant(,Wia)

3.

Roots and tender leaves of ginger

4.

Kuppamcniya leaves

5.

(Acalypha indica) Pavatta leaves Lidhatcdo vcuica1

158

KALINGA Tuooit

duction of western antimalarials with effect from the 1930s. It must be noted that several of the antimalarial herbal substances used in Nuwarakalaviya were also typically used as food items. Ginger and coriander were commonly used as spices. Sesame, ghee and mee tel were added to a variety of food preparations. The same substances were also used as medicine for a variety of other commonly occurring illnesses. As Etkin and Ross have shown for the Hausa of Nigeria, this varied and repeated use of the same herbal substances as food and as medicine for a variety of illnesses may have produced both a curative and prophylactic effect against malaria. It is important to consider whether there was any conception of a disease vector among the local people. None of the locally prevalent diseases was directly or indirectly attributed to mosquitoes. There was, however, a curious local belief which held that there was a marked proliferation of mosquitoes during the flowering of the rhora plant since it was held that the mosquitoes actually bred in the pollen of the relevant flower. Given the association between the peak rainfall season and flowering of the thora plant noted earlier, the perceived peak in mosquito breeding corresponds with reality. The local peasants, however, saw no relationship whatsoever between proliferation of mosquitoes and the annual outbreak of fever despite the fact that they considered both events to be associated with the annual flowering of the rhora plant. Thus they had correctly identified the peak seasons of both mosquito breeding and fever incidence, even though they did not perceive any relationship between these two events. Even though the mosquito was not seen as a disease vector, the local peasants considered it a major nuisance. In some folk poetry (pafknvi) the bite of the mosquitoes is presented as more menacing than the life-threatening dangers from certain wild animals. Hence, in Nuwarakalaviya as in the rest of Sri Lanka, there has been a long-established practice of burning certain local herbs as a method for driving away mosquitoes from homes and temporary watch huts in chenas at night. Some local plants such as mudururala (lit. mosquito plant, i.e. Ocitnum sunitum) were widely known for their mosquito repellent qualities [35]. Using a discarded earthenware vessel one or more of the substances such as madurutala, kohomba leaves, pungiri (pangiri grass), kohomba muru (a fibrous leftover from the process of extracting oil from the seeds of Azadirachta indica) mee muru (fibrous leftover from the process of extracting oil from the seeds of Maduca longifalia), cashew nut husks etc. were burnt all night in many local homes. In order to facilitate and prolong the smokes, coconut or paddy husks placed at the bottom of the vessel were burnt along with the herbs. The smokes which normally started at dusk continued till the dawn of the following day with herbal and other ingredients being added from time to time. It is likely that these smokes considerably helped the local people to protect themselves against the mosquitoes including the vectors during critical times of the night. Unlike other aspects of ethnopharmacopoeia,

SILVA

the practice of using smokes as a mosquito repellent continues to be important in purana villages in the Anuradhapura District even today. As in pastel tambuma, the ingredients used in mosquito repellent smokes were all essentially indigenous to the area. For the most part they were waste products such as coconut or paddy husks and kohombu or mee muru. It is also interesting to note that to some extent different products of the same locally available herbs (e.g. kohomba tel and kohomba muru; mee fel and mee muru) were used in herbal medication for malaria on the one hand and as mosquito repellents on the other. This shows that while the local peasants did not recognize any connection between fevers and mosquitoes, at the practical level there was some degree of integration between folk medication for malaria and the devices used locally for mosquito control. Finally, we may consider ritual practices related to malaria. It does not appear that locally malarial conditions came under the purview of any elaborate healing rituals such as pattini cult or sanni rituals. However, with the onset of any fever two relatively insignificant ritual acts, namely applying chanted oil (ref matirima) and tying a chanted thread around one’s neck (nuf badima), were usually performed. Both of these practices were seen as protective (uraksauotu) rather than curative devices as those with any physiological ailments such as fever were thought to be specially vulnerable to demonic attacks. In sum, locally malaria was perceived and dealt with largely through a localized secular herbal tradition.

CONCLUSION The peasants of Nuwarakalaviya traditionally perceived malaria as one of several related conditions characterized by repeated attacks of fever and fits. It was seen as a moderate disorder which could lead to further complications. There was a clear conception of both periodicity and seasonality of the disease. Though mosquitoes were viewed as a nuisance particularly acute in the malarial season, it was not recognized as a disease vector. The relevant perceptions and practices in Nuwarakalaviya and, as far as we can determine, in certain other malaria-endemic regions in Sri Lanka were determined by localized herbal traditions, which though in some ways affected by the scholarly ayurveda system were less sophisticated in conceptualizing causation of illness and choice of medications, but more firmly rooted in the local culture and the local ecosystem. In contrast to abstract and universal conceptions contained in ayurveda such as the humoural theory and ayurveda therapy which is partially dependent on imported medicines, the local concept of disease and the relevant preventive and curative practices were very much influenced by the specifics of the local ecosystem. It follows that the indigenous health belief systems in South Asia may be more diverse and less internally consistent than is commonly assumed. Just like many other aspects of the social structure and culture of purana villages described by Leach and

Ayurveda, malaria and the indigenbus herbal tradition

other observers [ 11.1617, the localized herbal tradition described here may be seen as an adaptive response to endemic malaria on the part of generations of local peasants assuming that the herbal remedies used had a curative, preventive or at least a mitigating effect on malaria. The main strength of the relevant herbal tradition was that it mobilized locally available natural resources in the forms of herbal medicines, food and mosquito repellents in a diversified and multifaceted attack on malaria. The herbal medicines for malaria have now been more or less completely replaced by western antimalarials and related concepts even in most remote villages in Nuwarakalaviya. For the most part this can be attributed to vigorous efforts under a vertical malaria eradication programme carried out by the state over the past four-and-a-half decades. However, it is significant that despite long years of residual insecticide application, the local peasants continue to rely on mosquito-repellent smokes using herbal ingredients. Moreover, the indigenous herbal tradition is continued by the local parampara vedas in the treatment of other locally prevalent ailments, such as snake bites, worm infestations and bone injuries. In this context it is important to note that, unlike the college-trained ayurvedics who have become more or less converted to western medicine as also reported by several other observers [18-191, the local parampara vedas whose practice is firmly grounded in the local culture, the local ecosystem and the related ethnopharmacopoeia, remain conscientious noncollaborators of powerful western medicine. Finally, the efficacy of these varied herbal remedies, including the herbal preparations traditionally used as a cure for malaria in various parts of Sri Lanka, must be scientifically assessed through future research. A comparative study of various herbal traditions in different malarious regions in South Asia may be necessary in order to identify the full range of variation as regards the local remedies for malaria and their relation to ayurveda. The corpus of ayurveda, in turn, may be re-examined in the light of data on various herbal traditions in South Asia, with a view to evolve an ayurveda doctrine and practice that build upon accumulated knowledge, experience and health resources in the whole of South Asia. Acknowledgemenls-This investigation received financial support from the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). Earlier versions of this paper were read at the Annual Congress of the Sri Lanka Association for the Advancement of Science held in Colombo in December 1987, and the Third International Congress in Traditional Asian Medicine held in Bombay in January 1990. Mr Piyadasa Wanninayaka and Mr S. Doolwala of the Sarvodaya Malaria Control Research Project assisted in data collection. The author gratefully acknowledges constructive comments on an earlier draft of this paper by Dr Sarath Edirisinghe (Department of Parasitology, University of Peradeniya), Dr P. Amarasinghe (Department Zoology, University of Peradeniya), Dr H. M. Senadheera (Ayurvedic Physician, Kandy Municipal Council), Dr Satish Jayanetti (Ayurvedic Physician, Kandy) and Mr Ajith Silva (Department of Community Medicine, University of Peradeniya).

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26. Ivers R. W. Manual of rhe North Central Province.

Government Printer, Colombo, 1899. 27. Carter H. F. Kataragama Fever: Its Nature, Causes and Control (Sessional Pauer 37 of 19251. Government Printer, i926. _ _ . 28. Rhys Davis T. W. Administration Report of the Government Agent, Nuwarakalaviya, 1971. Government Printer, Colombo, 1872. 29. Gill C. A. Report of the Malaria Epidemic in Ceylon I934/35 (Sessional Paper 23 of 1935). Government Printer, Colombo, 1936. 30. Reals, cited above, summarized the relevant South Indian conception as follows. “Excessive consumption of cucumbers or curds leads to cold; cold leads to head cold followed by a cough, by a chest cough, by whooping cough, and eventually malaria. The cure is to consume some heat-causing foods as garlic, brown sugar and beewax”.

31. Department of AYUNC& Sri L.anka Deshiya Chikitsa Sangrahaya. Dcuartmcntof Avurveda. Colombo. 1984. 32. Incidentally, E&in and Ross cited above found Carsi0 tora to be used as a cure for malaria among the Hausa of Nigeria. 33. Mahabodhi G. P. Jwara Niabna Granthaya. M. D. Gunasena, Colombo, 1973. 34. Personal communication with Mr P. G. R. Sarathchandra who was engaged in anthropological reaearch on malaria in the Hambantota District. In his field site in addition to some of the terms used in Nuwarakalaviya such as mura una, malaria was also known as “sengama/a una” (hepatitis fever). A localized herbal preparation called “sengamala ken&” was widely used as a cure for malaria in the Hambantota District. 35. It was also customary among the local peasants to grow around their homes a variety of plants believed to be giving out a smell repulsive to mosquitoes.