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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. 
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
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