Treatment of the mentally ill in the Chola Empire in 11(th) -12(th) centuries AD: A study of epigraphs.

The paper deals with the epigraphs of the Chola emperors Veera Rajendra Deva (1063-1069 AD) and Raja Raja III (1216-1256 AD), found at the temples of Thirumukkudal and Vedaranyam, with emphasis on the treatment given to the residents of the attached hospitals with special reference to treatment of mental disorders.

The treatment of mentally ill persons in asylums was started by the Arabs in the ancient city of Baghdad in 705 AD and then at Cairo in 800 AD.[1] Later the famous European asylums such as Bedlam, Salpetriere and the Madrid asylum were established. The Bethlem asylum which was commonly known as Bedlam was started in London in 1247 AD. Its location was changed many times in its long and chequered career. The Paris hospital for the treatment of mentally ill women, Salpetriere was founded by Louis XIV (1643-1715). It was originally the royal gunpowder factory, which, because of frequent accidental explosions was converted into an asylum. Pinel had liberated mentally ill patients from chains for the first time in the hospitals of Bicetre and Salpetriere.[2] Prior to the asylum era, most mentally ill patients were cared by the family. The harmless, “wandering lunatics” were found all over the country in the medieval period. The most famous of these is depicted by Shakespeare in his “King Lear” as Tom O’Bedlam.[3]

It is remarkable how a very early description of a wandering, harmless lunatic is described in the Tamil classic, Manimeghalai (c. 2nd century AD) written by the Buddhist Tamil poet Sathanar.

The heroine Manimeghalai encounters a severely disturbed individual. The song unfolds describing her encounter with a mad man on the way to the flower garden of Kaveripoompattinam, the famous east coast harbor of the early Cholas, which traded with Greece and Rome on the west, and the Kingdoms of South-East Asia including China.

Alari-flower used as an offering to the deities, erukkam-calotropis.

We also notice the attitude of the public, which is one of compassion and desire to help. There is no sense of fear, frivolity or prejudice or stigmatization of the mentally ill.[4] The care of the mentally ill was in the hands of the society, with obvious advantages and disadvantages, and many times led to ill-treatment, neglect and abandonment. This was to some extent corrected during the British Raj when monolithic structures in the form of large lunatic asylums were established as an innovation.[5] Very little is known about the care of mentally ill, in various parts of India, during its long history. Some areas are being clarified during the recent past, when extensive archaeological studies were undertaken, in various parts of our country. Subba Reddy, a pioneer in such studies (Former Professor of Physiology at Madras Medical College, Chennai, Later Principal, Gandhi Medical College, Hyderabad) established the National Institute of Indian Medical Heritage at Hyderabad. Students interested in the history of psychiatry with respect to India will be able to gather much information about the Thirumukkudal epigraph mentioned by Reddy (vide infra).[6]

There is no mention of specific care for the mentally ill in the Tamil land prior to the Thirumukkudal epigraph (see below). Many of the afflicted, both mental and physical, took “asylum” in the areas adjoining the temples devoted to saivite and vaishnavite Vedic religions and the Jain and Buddhist monasteries (quite prevalent in those days). Some such temples in Tamil Nadu which are frequented to, by people with mental illnesses, even to this day are situated in Gunasilam, Tiruvidaimaruthur, and Sholingur.[7]

The most important and relevant epigraph pertaining to the treatment of the afflicted in a hospital set up (Aadhular Salai) is found in Thirumukkudal temple of Lord Venkateswara (situated on the road between Chengalpattu and Kanchipuram). This temple is situated at the confluence of three sacred rivers Vegavati, Cheyyar and Palar (hence the name Thirumukkudal).

HISTORICAL BACKGROUND

This temple was built by Veera Rajendra Deva (1063-1069 AD). He is the son of the famous Chola emperor Rajendra (1014-1044 AD) who led a successful expedition to the Ganges valley and established a maritime empire comprising of Kadaram (modern Kedah of Malaysia and adjoining areas) and Srivijaya (modern Sumatra). Rajendra also established diplomatic relations with Cambodia and China. His son, Veera Rajendra successfully subdued the Western Chalukyas, the combined forces of the Cheras and Pandyas, and also established his supremacy over the Eelam territory (modern Sri Lanka).[8] He was also very religious like his father and grandfather, and built a number of temples including the one at Thirumukkudal.[910]

The inscription, found in this temple, is probably the first of its kind to give the composition of a small hospital of 15 beds and its staff. The hospital functioned in the Jananatha Mandapam in this temple. The hospital was named Veera Cholesvara Hospital and was provided with 15 beds. The hospital staff comprised of:

A doctor

A surgeon

2 male nurses who brought herbs and firewood, and prepared medicines

2 female nurses who administered doses of medicines, fed the patients, and attended to the cooking

A barber

A washer man

A potter

A gatekeeper.

Provision was made for burning a lamp for the whole night. Drugs were prepared in the hospital in the form of medicated ghee (ghritham), medicated oil (thailam) and medicated water (made by mixing cardamom and lemon). The oil was applied to the body or only to the head and was thought to reduce the heat (anal) in one's body. The external application of medicines was known as tuvalai. The other routes of administration of medicines were fumigation (vatu pitita), oral route (ullukku kottudal), nasal application (nasiyam), and ocular application (kallikam).[11] The various drugs used were:

The indications for the use of these drugs are not available in the epigraph, but can be found in the Ayurvedic text, Charaka Samhita.[12] Brahmi is a popular Ayurvedic and Siddha drug even today, used as a “neuroprotective” drug for the improvement of memory and intelligence. Kalyana lavanam is used for treatment of insanity in general, epilepsy and stammering. The above list consists of drugs like yellow myrobalan (haritaki in Sanskrit, kadukkai in Tamil) and castor oil which are popular purgatives (thought to reduce the excess bile, pittham, in one's body) used from ancient days for the treatment of mental illness, not only in India, but also in other parts of the world. Dasamoola haritaki is used for the treatment of mental illness in general.[1314]

It could be surmised that this early Chola Hospital antedating Bethlem Hospital was treating the mentally ill along with the others.

Now we will refer to another epigraph of the Chola king Raja Raja III (1216-1256 AD). Historical background: He was the last but one ruler of the decadent Chola Empire which was soon coming to an end. The subjugated Pandya dynasty of the earlier centuries became active under the able leadership of Maravarman Sundara Pandian and inflicted serious defeats on Raja Raja. His subordinate chieftains also rebelled against him and caused great damage and confusion. To extent, Raja Raja was protected by the now friendly Hoysalas. In spite of his misfortunes, King Raja Raja was a devout saivite, who built a number of temples, both saivite and vaishnavite. It is interesting to note that the greatest Saiva philosophy, Sivagnana Bodham, was written by the great philosopher, Meikandaar (literally the truth finder).

In the inscription on the north wall of the first prahara (corridor) of the Vedaranyeswara Temple, there is a reference to the asylum for the fearful (anjuvan pugalidam). We can be quite definite that this was utilized to accommodate the fearful and the needy in the prevailing political turmoil of the country.[9]

There are other epigraphic references to hospitals located along with the temples, but there are no details of treatment and drugs as noted above and these are omitted from our discussion for want of space. It can be safely concluded, from history and epigraphy, that mentally ill in the medieval period were looked after in small hospitals, like the one at Thirumukkudal and hospitals situated mostly in the secluded parts of temples.

The pattern of care of the mentally ill has undergone changes in various times and in various parts of the world. It has become more secular and more scientific. Such treatments have not completely shed their religious coverings as could be seen from the treatment afforded to them in our temples, churches and dargahs of today