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How the Buddha Died (part IV)

BUDDHISM Ancient texts weave two stories about the Lord Buddha's death. Was it planned and willed by the Buddha, or was it food poisoning, or something else altogether?

BY VENERABLE DR METTANANDO BHIKKHU
(article published in the Bangkok post Mai 17 2000)


Retrospective analysis

From the diagnosis given above, we can be rather certain that the Buddha suffered from mesenteric infarction caused by an occlusion of the supeior mesenteric artery. This was the cause of the pain that almost killed him a few months earlier during his last rainy season retreat. With the progress of the illness, some of the mucosal lining of his intestine sloughed off, amid this site became the origin of the bleeding. Arteriosclerosis, the hardening of the vessel wall caused by aging, was the cause of the arterial occlusion, a small blockage that did riot result in bloody diarrhoea, but is a symptom, also known to us as abdominal angina.
He had his second attack while he was eating the Sukaramaddava. The pain was probably not intense in the beginning, but made him feel that there was something wrong. Suspicious about the nature of the food, he asked his host to have it all buried, so that others might not suffer from it.

Soon, the Buddha realised that the illness was serious, with the passage of blood and more severe pain in his abdomen. Due to the loss of blood, he went into shock. The degree of dehydration was so severe that he could not maintain himself any longer and he had to take shelter at a tree along the way.
Feeling very thirsty and exhausted, he got Ananda to collect water for him to drink, even though he knew that the water was muddied.It was there that he collapsed until his entourage carried him to the nearest town, Kusinara, where there would have been a chance of finding a doctor or lodging for him to recover in.

It was probably true that the Buddha got better after drinking to replace his fluid loss, and resting on the stretcher. The experience with the symptoms told him that his sudden illness was the second attack of an existing disease. He told Ananda that the meal was not the cause of his illness, and that Cunda was not to blame. A patient with shock, dehydration and profuse blood loss usually feels very cold. This was the reason why he told his attendant to prepare a bed using four sheets of sanghati. According to Buddhist monastic discipline, a sanghati is a cloak, or extra piece of robe, very large, the size of a bed sheet, which the Buddha allowed monks and nuns to wear in winter.

bouddha couche sur les collines prés de Monywa

This information reflects how cold the Buddha felt because of his loss of blood. Clinically, it is not possible for a patient who is in a state of shock with severe abdominal pain, most likely peritonitis, pale and shivering, to be ambulatory. The Buddha was most likely put into a lodging, where he was nursed and warmed, located in the city of Kusinara. This view is also confirmed with the description of Ananda who, weeping, swoons and holds onto the door of his lodge after learning that the Buddha was about to pass away. Normally, a patient with mesenteric infarction could live 10 to 20 hours. From the sutta we learn that the Buddha died about 15 to 18 hours after the attack. During that time, his attendants would have tried their best to comfort him, for example, by warming the room where he was resting, or by dripping some water into his mouth to quench his lingering thirst, or by giving him some herbal drinks. But it would be highly unlikely that a shivering patient would need someone to fan him as is described in the sutta.

Off and on, he may have recovered from a state of exhaustion, allowing him to continue his dialogues with a few people. Most of his last words could have been true, and they were memorised by generations of monks until they were transcribed. But finally, late into the night, the Buddha died during a second wave of septic shock. His illness stemmed from natural causes coupled with his age, just as it would for anyone else.

Conclusion

The hypothesis outlined above explains several scenes in the narrative of the sutta, namely, the pressuring of Ananda to fetch water the Buddha's request for a fourfold cloak for his bed, the ordering of the meal to be buried, and so on. It also reveals another possibility of the actual means of transportation of the Buddha to Kusinara and the site of his death bed.
Sukaramaddava, whatever its nature, was unlikely to have been the direct cause of his illness. The Buddha did not die by food poisoning. Rather, it was the size of the meal, relatively too large for his already troubled digestive tract, that triggered the second attack of mesenteric infarction that brought an end to his life.

Dr Mettanando Bhikkhu was a physician before entering the monkhood. He is currently based at Wat Raja Orasaram