BUDDHA'S DEATH

During Wesak Day, we are informed that it is also the day Buddha attained Parinibbana. But not many know how the Buddha died. 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? Here's an account

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The Mahaparinibbana Sutta, from the Long Discourse of Pali Tipitaka, is without doubt the most reliable source for detailson the death of Siddhattha Gotama (BCE 563-483), the Lord Buddha. It is composed in a narrative style that allows readersto follow the story of the last days of the Buddha, beginning afew months before he died.

To understand what really happened to the Buddha is not a simple matter, though. The sutta, or discourse, paints two conflicting personalities of the Buddha, one overriding the other. 

The first personality was that of a miracle worker who beamed himself and his entourage of monks across the Ganges River (D II, 89), who had a divine vision of the settlement of gods on earth (D II, 87), who could live until the end of the world on condition that someone invite him to do so (D II, 103), who determined the time of his own death (D II, 105), and whose death was glorified by the shower of heavenly flowers and sandal powder and divine music (D II, 138). 

The other personality was that of an aged being who was failingin health (D II, 120), who almost lost his life because of a severe pain during his last retreat at Vesali (D II, 100), and who was forced to come to terms with his unexpected illness anddeath after consuming a special cuisine offered by his generoushost. 

These two personalities take turns emerging in different parts of the narrative. Moreover, there also appear to be two explanations of the Buddha's cause of death: One is that the Buddha died because his attendant, Ananda, failed to invite himto live on to the age of the world or even longer (D II, 117).

The other is that he died by a sudden illness which began afterhe ate what is known as "Sukaramaddava" (D II, 127-157). 

The former story was probably a legend, or the result of a political struggle within the Buddhist community during a stageof transition, whereas the latter sounds more realistic and accurate in describing a real life situation that happened in the Buddha's last days.

A number of studies have focused on the nature of the special cuisine that the Buddha ate during his last meal as being the agent of his death. However, there is also another approach based on the description of the symptoms and signs given in thesutta, which modern medical knowledge can shed light on. 

In another mural painting at Wat Ratchasittharam, the Lord Buddha is approaching death, but he still takes time to answer questions put forth by the ascetic Subhadda, his last convert who, after being admitted to the Buddhist Order, became an arahant (enlightened monk).

What we know

In the Mahaparinibbana Sutta, we are told that the Buddha became ill suddenly after he ate a special delicacy, Sukaramaddava, literally translated as "soft pork", which had been prepared by his generous host, Cunda Kammaraputta. The name of the cuisine has attracted the attention of many scholars, and it has been the focus of academic research on thenature of the meal or ingredients used in the cooking of this special dish. 

The sutta itself provides details concerning the signs and symptoms of his illness in addition to some reliable information about his circumstances over the previous four months, and these details are also medically significant.

The sutta begins with King Ajatasattus' plot to conquer a rivalstate, Vajji. The Buddha had journeyed to Vajji to enter his last rainy-season retreat. It was during this retreat that he

fell ill. The symptoms of the illness were sudden, severe pain. 

However, the sutta provides no description of the location and character of his pain. It mentions his illness briefly, and says that the pain was intense, and almost killed him.

Subsequently, the Buddha was visited by Mara, the God of Death,who invited him to pass away. The Buddha did not accept the invitation right away. It was only after Ananda, his attendant,failed to recognise his hint for an invitation to remain that he died. This piece of the message, though tied up with myth and supernaturalism, gives us some medically significant information. When the sutta was composed, its author was under the impression that the Buddha died, not because of the food heate, but because he already had an underlying illness that was serious and acute-and had the same symptoms of the disease thatfinally killed him.

The Timing

Theravada Buddhist tradition has adhered to the assumption thatthe historical Buddha passed away during the night of the full moon in the lunar month of Visakha (which falls sometime in Mayto June). But the timing contradicts information given in the sutta, which states clearly that the Buddha died soon after therainy-season retreat, most likely during the autumn or mid-winter, that is, November to January.

A description of the miracle of the unseasonal blooming of leaves and flowers on the sala trees, when the Buddha was laid down between them, indicates the time frame given in the sutta. 

Autumn and winter, however, are seasons that are not favourablefor the growth of mushrooms, which some scholars believe to be the source of the poison that the Buddha ate during his last meal.

Diagnosis

The sutta tells us that the Buddha felt ill immediately after eating the Sukaramaddava. Since we do not know anything about the nature of this food, it is difficult to name it as the direct cause of the Buddha's illness. But from the descriptionsgiven, the onset of the illness was quick. 

While eating, he felt there was something wrong with the food and he suggested his host have the food buried. Soon afterward,he suffered severe stomach pain and passed blood from his rectum. 

We can reasonably assume that the illness started while he was having his meal, making him think there was something wrong with the unfamiliar delicacy. Out of his compassion for others,he had it buried. 

Was food poisoning the cause of the illness? It seems unlikely. The symptoms described do not indicate food poisoning, which can be very acute, but would hardly cause diarrhoea with blood. Usually, food poisoning caused by bacteria does not manifest itself immediately, but takes an incubation period of two to 12 hours to manifest itself, normally with acute diarrhoea and vomiting, but not the passageof blood. 

Another possibility is chemical poisoning, which also has an immediate effect, but it is unusual for chemical poisoning to cause severe intestinal bleeding. Food poisoning with immediateintestinal bleeding could only have been caused by corrosive chemicals such as strong acids, which can easily lead to immediate illness. But corrosive chemicals should have caused bleeding in the upper intestinal tract, leading to vomiting blood. None of these severe signs are mentioned in the text.

Peptic ulcer diseases can be excluded from the list of possibleillnesses as well. In spite of the fact that their onset is immediate, they are seldom accompanied by bloody stool. A gastric ulcer with intestinal bleeding produces black stool

when the ulcer penetrates a blood vessel. An ulcer higher up inthe digestive tract would be more likely to manifest itself as bloody vomiting, not a passage of blood through the rectum.

Other evidence against this possibility is that a patient with a large gastric ulcer usually does not have an appetite. By accepting the invitation for lunch with the host, we can assumethat the Buddha felt as healthy as any man in his early 80s would feel. Given his age we cannot rule out that the Buddha did not have a chronic disease, such as cancer or tuberculosis or a tropical infection such as dysentery or typhoid, which could have been quite common in the Buddha's time. 

These diseases could produce bleeding of the lower intestine, depending on their location. They also agree with the history of his earlier illness during the retreat. But they can be ruled out, since they are usually accompanied by other symptoms, such as lethargy, loss of appetite, weight loss, growth or mass in the abdomen. None of these symptoms were mentioned in the sutta.

A large haemorrhoid can cause severe rectal bleeding, but it isunlikely that a haemorrhoid could cause severe abdominal pain unless it is strangulated. But then it would have greatly disturbed the walking of the Buddha to the house of his host, and rarely is haemorrhoid bleeding triggered by a meal.

Mesenteric infarction

A disease that matches the described symptoms-accompanied by acute abdominal pain and the passage of blood, commonly found among elderly people, and triggered by a meal-is mesenteric infarction, caused by an obstruction of the blood vessels of the mesentery. It is lethal. Acute mesenteric ischaemia (a reduction in the blood supply to the mesentery) is a grave condition with a high rate of mortality.

The mesentery is a part of the intestinal wall that binds the whole intestinal tract to the abdominal cavity. An infarction of the vessels of the mesentery normally causes the death of

the tissue in a large section of the intestinal tract, which results in a laceration of the intestinal wall. 

This normally produces severe pain in the abdomen and the passage of blood. The patient usually dies of acute blood loss. This condition matches the information given in the sutta. It is also confirmed later when the Buddha asked Ananda to fetch some water for him to drink, indicating intense thirst. 

As the story goes, Ananda refused, as he saw no source for clean water. He argued with the Buddha that the nearby stream had been muddied by a large caravan of carts. But the Buddha insisted he fetch water anyway. 

A question arises at this point: Why did the Buddha not go to the water himself, instead of pressing his unwilling attendant to do so? The answer is simple. The Buddha was suffering from shock caused by severe blood loss. He could no longer walk, andfrom then to his death bed he was most likely carried on a stretcher. 

If this was indeed the situation, the sutta remains silent about the Buddha's travelling to his deathbed, possibly becausethe author felt that it would be an embarrassment for the Buddha. Geographically, we know that the distance between the place believed to be the house of Cunda and the place where theBuddha died was about 15 to 20 kilometres. It is not possible for a patient with such a grave illness to walk such a distance. 

More likely, what happened was that the Buddha was carried on astretcher by a group of monks to Kusinara (Kushinagara). 

It remains a point of debate whether the Buddha really determined to pass away at this city, presumably not much larger than a town. From the direction of the Buddha's journey,given in the sutta, he was moving north from Rajagaha. It is possible that he did not intend to die there, but in the town where he was born, which would have taken a period of three

months to reach.

From the sutta, it is clear that the Buddha was not anticipating his sudden illness, or else he would not have accepted the invitation of his host. Kusinara was probably the nearest town where he could find a doctor to take care of him. It is not difficult to see a group of monks hurriedly carrying the Buddha on a stretcher to the nearest town to save his life.

Before passing away, the Buddha told Ananda that Cunda was not to be blamed and that his death was not caused by eating Sukaramaddava. The statement is significant. The meal was not the direct cause of his death. The Buddha knew that the symptomwas a repeat of an experience he'd had a few months earlier, the one which had almost killed him.

Sukaramaddava, no matter the ingredients or how it was cooked, was not the direct cause of his sudden illness.

Progression of the disease

Mesenteric infarction is a disease commonly found among elderlypeople, caused by the obstruction of the main artery that supplies the middle section of the bowel-the small intestine-with blood. The most common cause of the obstruction is the degeneration of the wall of the blood vessel, the superior mesenteric artery, causing severe abdominal pain, also known asabdominal angina.

Normally, the pain is triggered by a large meal, which requiresa higher flow of blood to the digestive tract. As the obstruction persists, the bowel is deprived of its blood supply, which subsequently leads to an infarction, or gangrene,of a section of the intestinal tract. This in turn results in alaceration of the intestinal wall, profuse bleeding into the intestinal tract, and then bloody diarrhoea.

The disease gets worse as the liquid and content of the intestine oozes out into the peritoneal cavity, causing peritonitis or inflammation of the abdominal walls. This is

already a lethal condition for the patient, who often dies due to the loss of blood and other fluid. If it is not corrected bysurgery, the disease often progresses to septic shock due to bacterial toxins infiltrating the blood stream.

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 superior mesenteric artery. This was the causeof 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 ofhis intestine sloughed off, and this site became the origin of the bleeding. Arteriosclerosis, the hardening of the vessel wall caused by ageing, was the cause of the arterial occlusion,a small blockage that did not 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, sothat 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 ifsanghati nf. According to Buddhist monastic discipline, a ifsanghati nfis a cloak, or extra piece of robe, very large, the size of a bed sheet, which the Budd ha 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 patientwho 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 thatthe Buddha was about to pass away.

Normally, a patient with mesenteric infarction could live 10 to20 hours. From the sutta we learn that the Buddha died about 15to 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 memorisedby 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, Thailand.

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Anyone who is known to take an interest in the history of Buddhism is bound to be asked from time to time whether it is true that Buddha died of eating pork. The idea that he should have done so comes as a surprise to most Eurpoeans; for we are in the habit of regarding vegetarianism as an intrinsic part of Buddhism. Enquirers with an iconoclastic bend of mind are anxious to have it confirmed that Buddha was something quite different from the conventional holy man ¢w something robuster at the same time less pretentious; while those who have treasured the figure of Gautama the Saint, immune from every worldly appetite or desire, are eager to

secure authority for a figurative interpretation of the pork-eating passage.(1) The ease with which such a question is answered depends on the extent of the informant's researches. Regarding the passage by itself and merely from the point of view of Pali Buddhism, I think anyone not influenced by romantic preconceptions about Buddha's personality must come to the conclusion(2) that the words suukara-maddava('pig-soft') are to be taken literally. So soon however as one studies the question from a wider aspect and, taking into consideration the equally early(3) Chinese Hiinayaana ¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w 1 Mahaaparinibbaana-sutta(Diighanikaaya 16). Tran- slated in Dilogues of the Buddha II, 137. 2 As recently the editors of the Pali Text Society's dictionary have done. 3 I know of no reason for regarding the Sanskrit AAgamas (preserved in Chinese) in general as later than the Pali Niikaayas. In some cases they can certainly be shown to be earlier. The same applies to the various Hiinayaana Vinayas (Monastic Rules) preserved in Chinese.

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documents, traces the history of the Buddhist attitude towards the eating of meat, the whole question becomes infinitely more complicated, and a confident answer far less easy to give. The story of Buddha's last meal, as told in the Mahaaparinibbaana-sutta ('Book of the Great Decease') is well summed up by E.J.Thomas(1). At Paavaa, Budha stayed in the mango grove of Cunda Thomas(1). At Paavaa, Buddha stayed in the mango grove of Cundathe smith. There Cunda provided a meal with the excellent food, hard and soft, and a large amount of suukaramaddava. Before the meal Buddha said, ((Serve me, Cunda, with the suukaramaddava that you have prepared, and serve the order with the other hard and soft food.)) Cunda did so, and after the meal Buddha told him to throw the remainder of the suukaramaddava into a hole, as he saw no-one in the world who could digest it other than the Tathaagata.(2) The sharp sickness arose, with flow of blood, and violent deadly pains, but Buddha mindful and conscious controlled them...and set out for Kusinaaraa.

Tje word suukaramaddava occurs nowhere else(except in discussions of this passage) and the -maddddava part is capable of at least four interpretations. Granting that it comes from the root MRD 'soft', cognate with Latin mollis, it is still ambiguous, for it may either mean 'the soft parts of a pig' or 'pig's sofg-food' i.e. food eaten by pigs.(3) But it may again come from the same root as our word 'mill' and mean'pig-pounded', i.e. 'trampled by pigs'. There is yet another similar root meaning 'to be pleased', and as will be seen below one scholar has supposed the existence of a vegetable called 'pig's-delight'. The question whether Buddha did or did not die of eating pork has naturally presented itself to the lay mind as a theological one. Actually, however, no theological point is involved. Even specialists have very imperfectly realized that till late in the history of Bud- ¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w 1 The Life of Buddddha (Kegan Paul. 1927)p.149. 2 No feature in the story is stranger than this apparent touch of irony. 3 If derived from this root maddava may be copmared etymologically to our word 'mallow', the soft plant.

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dhism, the eating of flesh was permitted, except under certain exceptional circumstances. The Buddhist monk must refrain from eating meat if he 'knows, hears or infers' that it has been killed specially for him(1). The latitude allowed was very great; for example, it was considered wrong for a monk to go to a house and ask for meat, unless he was ill. But he might ask for it if the householder said to him 'Is there anything else you could fancy?' It was therefore not in the least suprising that in commenting on the Diigha-nikaaya's account of Buddha's last meal, Buddhaghosha (beginning of the 5th century) should have been quite content to take suukara-maddava as meaning pork. But the commentary on the Udaana(3), in dealing with this passage, says: suukara-maddava in the Great Commentary(4) is said to be the flesh of a pig made soft and oily; but some say it was not pig's flesh but the sprout of a plant trodden by pigs; other that it was a mushroom growing in a place trodden by pigs; other

again have taken it in the sense of a flavouring substance. One's first impression on reading these 'vegetarian' explanations is that they are pure sophistry, dating from a time when the idea of Buddha's eating flesh was so unacceptable that the commentators felt obliged at all costs to twist the passage into another meaning. If no other vegetable names of similar formation existed, it would indeed seem almost certain that the 'mushroom' explanation was a mere flight of fancy. But Neumann(5) has shown that in Narahari's Raajanigha.n.tu, among the names of medical plants, there occurs a whole series of compound words having 'pig' as their first element; thus suukara-kanda, 'pig-bulb': suukara-paadika, 'pig's ¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w 1 Majjhima Nikaaya (Jiivaka Sutta) 55. There is, I think, no corresponding suutra in the Chinese aagamas; but the same permission is given in the Chinese Hinayaana Vinayas, e.g. Ss ¡¼ F^en L ¡¼, 58 (Taishoo Tripi.taka xxii, 998b). 2 Exposition of the Muulasarvaastivaadin Vinaya. Taishoo Tripitaka, xxiv, 588. 3 i, 399; Steinthal's edition of the Udaana, p. 81 seq. 4 Now lost. For this passage, see Edward Thomas, loc. cit. 5 Preface to the Majjhima Nikaaya, p.xx.

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foot', sukaresh.ta ('sought-out by pigs'). On the analogy of the last, Neumann takes suukaramaddava to mean 'pig's delight', and assumes that it is the name of some kind of truffles. It seems to me that philologically Neumann's view has much to be said for it and has not been sufficiently taken into account. It is perfectly conceivable that the commentators who have been suspected of 'explaining away' the expression 'pork' were in reality better informed than Buddhaghosha. Plant names tend to be local and dialectical. It is quite likely that if such an expression as suukara-maddava meant 'truffles' in Maghada, it might, in the more western and southern centres where Pali Buddhism came into existence, have been entirely unknown and consequently misunderstood. Unfortunately the term, so far as is known, occurs

only in this passage and in discussions of it. In Sanskrit no corresponding expression seems to exist at all.

The Chinese Hiinayaana documents.

The account of Buddha's Decease occurs in the sec- ond book of the Diirghaagama(1). This version was translated in 412-413 and is therefore contemporary with Buddhaghosha. It supports the 'vegetarian' theory. Cunda makes 'a separate stew of ears of the sandal-wood tree, which the world esteems as a great dainty'. 'Treeear' is still the current Chinese for a fungus growing on a tree. Fragments of the Sanskrit Diirghaagama exist, but unfortunately not his passage. Presumably the Sanskrit phrase in front of the Chinese translator was Candana ahicchatraka, candanachattra or the like. There are four other versions of the Hiinayaana Great Decease. (1) Nanjio 552,translated in 290-306 by Po Fa-tsu. (2) Nanjio 119,translator unknown. (3) Nanjio 118,falsely attributed to Fa-hsien. (4) A long passage(2) in the Kshuraka-vaastu of the Muula-sar-vaastivaada Vinaya (translated in 710). ¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w 1 Taishoo Tripi.taka, i, 18b. 2 ibid. xxiv, 382 seq.

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In none of these works is the nature of the food offered by Cunda specified. The passage is quoted in the Milinda Questions (¡± 175); but in a section that is lacking in the Chinese versions. The idea then that Buddha died of eating pork is wholly absent from the Chinese Canon, and can never have entered the head of any Far Eastern Buddhist till the Pali scriptures began to be studied at the end of the 19th century. There was indeed another occasion (1) when Buddha accepted a similar offering. The householder Ugga brought him some suukarama.msa. Here again the Chinese Canon fails us, for this sutta does not exist in the Ekottaraagama or elsewhere. No-one,I think, has ever suggested that suukara-ma.msa('pig's flesh') does not mean pork. All that has been said so far applies only to the

Hiinayaana. From the Mahaayaana standpoint not merely a philological but a moral issue is involved; for as is well known many of the principal Mahaayaana scriptures forbid the eating of flesh altogether. The earliest work to contain such a prohibition (2) is the Mahaaparinirvaa.na Suutra, a Mahaayaana remodelling of the old Suutra of the Great Decease. When Fa-hsien visited India early in the 5th century, he found that in the whole of the Middle Country (Madhyade'sa i.e. Magadha and the surrounding parts) 'the people abstain from taking life. They drink no wine nor do they eat onions or garlic...they do not breed pigs or poultry or sell any animal food'(3). ¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w 1 See A^nguttara Nikaaya, Vol. III, 49, (Manaapad- aayii). 2 Fa-hsien's translation (Nanjio, 120), Taishoo Tripi.taka, xii,868c.The wording in the Dharmakshema version (Thaishoo Tripi.taka xii, 386b) is identical. The so-called Southern Version (Nanjio 114) is merely a transcript of Nanjio 113 with a division of chapters imitated from Nanjio 118 and a few verb alalterations. [On peut signaler ici les Suutras de Maitreya resumes par P.Demieville, BEFEO. 1920, 4, p.165-167: ((L'ermite fait voeu de ne jamais manger de viande, ainsi que l'ordonnent les suutras de misericorde de tous les buddhas...AAnanda fait remarquer combien est ((etrange et particuliere)) cette prescription de s'abstenir de viande.)) ¢w Morale bouddhique, 63-64.] 3 Taishoo Tripi.taka, i, 859b.

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Had Fa-hsien enquired what scriptural authority there was for this absolute prohibition of meat, no doubt the Mahaaparinirvaa.na Suutra would have been pointed to. And it is certain that Fa-hsien took a particular interest in this suutra, for he acquired a copy of it in Paa.taliputra, and it was this version that he translated into Chinese in 417 A.D. What was the origin of this new view about meat-eating, which seems to have sprung up somewhere about the 3rd century? An explanation that at once occurs to me is as follows: The Gupta kings, who at this period ruled

over the Middle Country, though they tolerated Buddhism and sometimes even supported it, were themselves worshippers of Vish.nu. Now the Vaishnavite ascetic 'must abstain from animal food of any kind'(1), and it must naturally have occurred to Buddhists to say 'If even the misguided Hindus abstain from meat, how much the less ought we...' or something of that kind. Such an hypothesis finds complete confirmation in the La^nkaavataara Suutra (2) , a work somewhat later than the Mahaaparinirvaa.na: 'If even the infidels in their heretical treatises and the Lokaayatikas in their worldy teachings and those who fall into the error of regarding (the dharmas) either as permanent or as without duration, as existent or as non-existent, even such people forbid the eating of meat...' Again(3): 'Even secular magicians abstain from meat, knowing that upon this depends the success of their performance; how much the more must my disciples in pursuit of the Tathaagata's supreme way of spiritual release..' etc. The La^nkaavataara has indeed a special chapter(4) (Ma.msabhaksha.na) dealing with the prohibition of meat. To justify this prohibition it refers to five suutras(5): the A^nguli- ¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w 1 Vish.nu Sm.rti, 51,72 (Sacred Books of the East, vii, 171). 2 Bodhiruci's translation.Taishoo Tripi.taka, xvi, 561a. 3 Taishoo Tripi.taka, xvi, 562b. 4 Gu.nabhadra's translation ( 443 A. D. ), Taishoo Tripi.taka, xvi, 513c. 5 Gu.nabhadra's translation (514b) adds the Mahaa- nirvaa.na, and substitutes the 'Sriimaalaa for the A^ngulimaala.

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maataa,the Mahaanegha, the 'Sriimaalaa, the Hastika- kshya and the Mahaa-parinirvaa.na. The first is a well-known Hiinayaana sutta and in its early form(1) of course contains no such prohibition. It exists however in an expanded Mahaayaana form, and in one passage(2) says that the 'Buddhas do not eat flesh'. The second (translated 414-421) contains only a very indefinite reference(3) to the question.

The third contains no reference to the subject at all, and is obviously quoted by mistake for the A^ngulimaala. The fourth(4) merely says that the efficacy of the spell at the end of the suutra depends on abstinence from flesh. It is evident that at the time when the La^nkaavataara was composed, the Mahaaparinirvaa.na was the only scripture that definitely forbade the eating of meat. When therefore the Mahaayaana set itself to produce its own set of monastic rules, it had but the slenderest authority for enforcing complete vegetarianism. And indeed in the Fan-wang Ching(5), which Far Eastern Buddhists regard as the foundation of their Monastic Rules, flesh-eating does not rank as a major sin, but merely as one of the forty-eight 'light defilements'. It is thus regarded as less serious than, for example, losing one's temper. But to return to the question of Buddha's last meal ¢wwe have seen that philologically there is no reason why suukara-maddava ¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w 1 Majjhima-nikaaya 86. Sa^myuktaagama 1077. Taisnoo Tripi.taka ii, 281. 2 Ibid, ii, 540. 3 Ibid, xii, 1099c. 4 Ibid, xvii, 787a. Translated in 424-441. 5 Ibid, xxiv, 1005b. It purports to be an extract from a long Sanskrit work. But the Chung Ching Mu Lu (Nanjio 1609; compiled in 594 A.D.) dismisses it as a forgery. The Tibetan version, which has no Sanskrit title and merely prefixes a literal rendering of the full Chinese title, is probably translated from the Chinese. It seems likely indeed that the work was originally composed in China some time after 507; for in that year, at a conference convened by the emperor Wu of the Liang dynasty to discuss the question of meat-eating, the Fan-wang Ching is not cited among other relevant scriptures. It is interesting that one of the Vinaya authorities who gave evidence at this enquiry confessed that he was not himself a vegetarian (Taisho, Lii, 299).

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should not be the name of a root or fungus. And granted that this was the original meaning, it is quite comprehensible that after the centre of Buddhism shifted westward and southward(1), this

original meaning may have been forgotten. Had Hiinayaana Buddhism viewed the eating of flesh with abhorrence, the expounders of the Sutta would then have found themselves in an embarrassing position. Actually, however, they had(as we have seen) no such prejudice and it was quite easy for them to accept the term suukara-maddava in the sense pork. The 'other commentators', who maintained that a vegetable was meant, were on this hypothesis not dishonest theologians, but merely people who happened to come from some part of India where the term suukara-maddddava in a vegetable sense was still current. I know of no argument that could render such an hypothesis untenable. The alternative is to suppose that, although no existing Hiinayaana work contains any general prohibition of uthe eating of meat, the feeling in favour of vegetarianism, then rather generally prevalent in the world(2) , had affected the Hiinayaana as well as the Mahaayaana, with the result that certain commentators were shocked by the idea of Buddha's eating pork, and invented a fanciful inter-pretation of the passage. The same sentiment, it must be supposed, is responsible for the subtitution of fungi for pork in the Chinese version. I think the second theory involves rather larger unproved assumptions than the first. But, in the existing state of our knowledge, either seems to me to be reasonable. The interest of such an enquiry as the above, despite its negative result, lies in the picture it gives of the method by which Buddhism adapted itself to fresh currents of thought and feeling in a method in complete contrast with that of Christianity. Whenever, under the influence of fresh environment or creative individual thought, the Buddhists were attracted ¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w 1 After the persecutions of Pushyamitra ( 185-148 B.C.). 2 The Christian gnostics also advocated complete vegetarianism.

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by a new point of view, they felt the necessity of investing this point of view with written authority. Thus, so long as the religion was a living organism,

its scriptures continually expanded and the Tripi.taka in its Hiinayaana and Mahaayaana forms is in itself a history of Buddhism. Such a method, implying as it does in the faithful a critical capacity so limited that they will be at any moment ready to accept a modern document as the newly-recovered teaching of the Founder, was not possible in the West. Instead, the Christian Church has often been forced to adopt a complicated metaphorical interpretation of its Seriptures, particularly of the Old Testament, but has (since a very early period) scrupulously avoided the policy of expansion and interpolation which produced the riches of the Tripi.taka. Thus, whereas in the West it is to the works of theologians that we must turn if we wish to study the successive phases of Christianity, in Buddhism the whle process of growth lies open before us in the scriptures themselves. The Western method has its advantages. It is easy to regard past theologians as fallible. In Buddhism on the contary the successive stages of doctrine, often irreconcilable with what went before, are expounded in scriptures which all make equal claim to be the actual words of Buddha. The difficulty was met, inadequately enough, by maintaining that the later scriptures had been mysteriously 'held up' till the world was in a fit state to receive them. In a case such as the one I have been discussing, this type of explanation could not be very convincing, and it is not surprising to find the great Buddhist biographer and compiler Tao-hsuan (596-667), who founded a sect which based its teaching on the Vinaya, embarrassed by the fact that in this portion of the Scriptures the eating of flesh (regarded by 7th century Buddhists with horror) was most definitely permitted. Fortunately the difficulty was solved by a vision in which a prpohecy(1) was revealed to him, to the ¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w 1 FA Yuan Chu-lin, Ch. 94. Taishoo Tripi.taka Lvii, 980c, quoting Tao-hsuan's lost I-fa Chu-chih Kan-ying Chi: 'Record of Rewards to those who held fast to the remnants of the Law.'

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effect that in the degenerate days long after Buddha's death there would be monks who finding support in passages of the Hiinayaana scriptures

would misinterpret the meaning of the Vinaya and pretend that Buddha allowed the monks to eat meat. 'In those days the monks in their temples will slay living creatures, making the places they live in no better than the homes of hunters or butchers.'

Buddha's Image.

To illustrate the way in whcih disearded doctrines have left their mark on the Tripi.taka, I will discuss, as an appendix to this essay, an opposite case: one in which a former prohibition was subsequently withdrawn. It is well-known to all students of Indian art that in the earliest Buddhist monuments ¢w at Saanehii, Baarhut and Bodhgayaa-the figure of Buddha is not represented, but replaced by some symbol, such as the Wheel of the Law, or an empty throne. Modern Buddhists can furnish no explanation of this peculiar fact, and European writers (among them, M.Foucher(1)) have generally been content to accept the Indian view that, if early Buddhist art did not represent the Buddha, it was 'because it was not customary to do so'. I do not think any European scholar(2) has noted the fact that a definite embargo on the representation of Buddha is referred to in the Chinese Tripi.taka. In Chapter 48 of the Vinaya of the Sarvaastivaadins (3) there is a long passage which deals with the decoration of monasteries. Anaathapi.n.dika says to Buddha: 'World-honoured one, if images of yours are not allowed to be made, pray may we not at least make images of Bodhisattvas(4) in attendance upon you?' Buddha then grants this permission. ¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w 1 The Beginnings of Buddhist Art, p.7. 2 Attention was briefly called to the passage by Iwasaki Masumi, in a review of M.Foucher's book, Kokkwa, May 1920. 3 The Shih Sung Lu,Taishoo Tripi.taka, xxiii, 352. 4 Though in later Buddhism new ideas centred round the term Boddhisattva, its occurrence does not necessarily imply a late date. Possibly some of the figures identified as Naagas in early Buddhist sculpture would have been regarded by the writer of this passage as Bodhisattvas.

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All branches of the Sarvaastivaadin School were however apparently not in agreement on this point, for, in the Vinaya(1) of the Cashmirian branch, the same Anaathapi.n.dika asks if it is permissible to make images of the Buddha's earthly semblance, and is told that there is no objection to doing so. The first work was translated into Chinese in 404. It would I think be generally accepted that the original goes back at least to the 1st century A.D. The occurrence in it of the passage I have quoted suggests that it goes back still further, or, at any rate, that certain elements in it reflect the state of affairs, with regard to the representation of Buddha's figure, that we are familiar with at Saanchi, Baarhut and Bodhgayaa; that is to say, it is in part at least as early as the first century B.C. The second work, the Nidaana, is certainly much later. The cult of images, influenced perhaps in part by Hinduism and in part by contact with the Hellenistic world, seems to have been adopted by Hiinayaana and Mahaayaana Buddhism more or less simultaneously. To justify it, a story was told of how the great kings Udayana and Prasenajit made the first images of Buddha during the Blessed One's absence in the Trayastrim'sa heaven, which he had visited in order to convert his mother. Variants of the story are found both in the Hiinayaana and the Mahaayaana Canon. In the 28th chapter of the Ekottaraagama(2), Udayana makes an image of sandalwood five feet high and Prasenajit follows suit with a golden image. There is no corresponding passage in the A^nguttara Nikaaya(3), nor anywhere in the Pali Canon. The legend makes its appearanc e in other works translated about the same time. Thus in the Kuan Fo San-mei Hai Ching(4) Udayana makes a golden image. More commonly there is only one ¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w 1 Muulasarvaastivaada-nidaana, Taishoo Tripi.taka, xxiv, 434b.Translated in 170 A.D. 2 Taishoo Tripi.taka,ii,706.Translated in 384- 385. 3 The Pali equivalent to the Ekottaraagama. 4 Taishoo Tripi.taka, xv, 678b, Chapter vi.

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image, a wooden one made by Prasenajit. This version of the story was heard in India by the pilgrim Fa-hsien(1) early in the 5th century, and by

Hsuan-tsang(2) in the 7th. It is possible that future research will discover passages in the Pali Vinaya which have some bearing on the introduction of the cult of images. But the innovation was one which took place at so early a period in Buddhist history that we should not in any case expect to find much echo of it in the written records, all of which were redacted at a comparatively late period. Indeed, were it not for the existence of early Buddhist sculpture, the passage I have quoted from the Vinaya of the Sarvaastivaadins would be uninteligible. The change in the Buddhist attitude towards flesh-eating took place at a far later date, long after the written redaction of the Hiinayaana Canon, and consequently the whole process lies open before us. The fact that, in Buddhist scriptures, it is possible to trace the evolution of such a change says much for the fidelity with which the Cannon has been transmitted. ¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w¢w 1 Ibid. li, 860b. 2 Ibid. 899b.

During Wesak Day, we are informed that it is also the day Buddha attained Parinibbana. But not many know how the Buddha died. 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? Here's an account

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The Mahaparinibbana Sutta, from the Long Discourse of Pali Tipitaka, is without doubt the most reliable source for details on the death of Siddhattha Gotama (BCE 563-483), the Lord Buddha. It is composed in a narrative style that allows readers to follow the story of the last days of the Buddha, beginning a few months before he died.

To understand what really happened to the Buddha is not a simple matter, though. The sutta, or discourse, paints two conflicting personalities of the Buddha, one overriding the other. 

The first personality was that of a miracle worker who beamed himself and his entourage of monks across the Ganges River (D

II, 89), who had a divine vision of the settlement of gods on earth (D II, 87), who could live until the end of the world oncondition that someone invite him to do so (D II, 103), who determined the time of his own death (D II, 105), and whose death was glorified by the shower of heavenly flowers and sandal powder and divine music (D II, 138). 

The other personality was that of an aged being who was failing in health (D II, 120), who almost lost his life because of a severe pain during his last retreat at Vesali (D II, 100), and who was forced to come to terms with his unexpected illness and death after consuming a special cuisineoffered by his generous host. 

These two personalities take turns emerging in different partsof the narrative. Moreover, there also appear to be two explanations of the Buddha's cause of death: One is that the Buddha died because his attendant, Ananda, failed to invite him to live on to the age of the world or even longer (D II, 117). The other is that he died by a sudden illness which began after he ate what is known as "Sukaramaddava" (D II, 127-157). 

The former story was probably a legend, or the result of a political struggle within the Buddhist community during a stage of transition, whereas the latter sounds more realistic and accurate in describing a real life situation that happenedin the Buddha's last days.

A number of studies have focused on the nature of the special cuisine that the Buddha ate during his last meal as being the agent of his death. However, there is also another approach based on the description of the symptoms and signs given in the sutta, which modern medical knowledge can shed light on. 

In another mural painting at Wat Ratchasittharam, the Lord Buddha is approaching death, but he still takes time to answerquestions put forth by the ascetic Subhadda, his last convert who, after being admitted to the Buddhist Order, became an arahant (enlightened monk).

What we know

In the Mahaparinibbana Sutta, we are told that the Buddha became ill suddenly after he ate a special delicacy, Sukaramaddava, literally translated as "soft pork", which had been prepared by his generous host, Cunda Kammaraputta. The name of the cuisine has attracted the attention of many scholars, and it has been the focus of academic research on the nature of the meal or ingredients used in the cooking of this special dish. 

The sutta itself provides details concerning the signs and symptoms of his illness in addition to some reliable information about his circumstances over the previous four months, and these details are also medically significant.

The sutta begins with King Ajatasattus' plot to conquer a rival state, Vajji. The Buddha had journeyed to Vajji to enterhis last rainy-season retreat. It was during this retreat thathe fell ill. The symptoms of the illness were sudden, severe pain. 

However, the sutta provides no description of the location andcharacter of his pain. It mentions his illness briefly, and says that the pain was intense, and almost killed him.

Subsequently, the Buddha was visited by Mara, the God of Death, who invited him to pass away. The Buddha did not acceptthe invitation right away. It was only after Ananda, his attendant, failed to recognise his hint for an invitation to remain that he died. This piece of the message, though tied upwith myth and supernaturalism, gives us some medically significant information. When the sutta was composed, its author was under the impression that the Buddha died, not because of the food he ate, but because he already had an underlying illness that was serious and acute-and had the samesymptoms of the disease that finally killed him.

The Timing

Theravada Buddhist tradition has adhered to the assumption that the historical Buddha passed away during the night of thefull moon in the lunar month of Visakha (which falls sometime in May to June). But the timing contradicts information given in the sutta, which states clearly that the Buddha died soon

after the rainy-season retreat, most likely during the autumn or mid-winter, that is, November to January.

A description of the miracle of the unseasonal blooming of leaves and flowers on the sala trees, when the Buddha was laiddown between them, indicates the time frame given in the sutta. 

Autumn and winter, however, are seasons that are not favourable for the growth of mushrooms, which some scholars believe to be the source of the poison that the Buddha ate during his last meal.

Diagnosis

The sutta tells us that the Buddha felt ill immediately after eating the Sukaramaddava. Since we do not know anything about the nature of this food, it is difficult to name it as the direct cause of the Buddha's illness. But from the descriptions given, the onset of the illness was quick. 

While eating, he felt there was something wrong with the food and he suggested his host have the food buried. Soon afterward, he suffered severe stomach pain and passed blood from his rectum. 

We can reasonably assume that the illness started while he washaving his meal, making him think there was something wrong with the unfamiliar delicacy. Out of his compassion for others, he had it buried. 

Was food poisoning the cause of the illness? It seems unlikely. The symptoms described do not indicate food poisoning, which can be very acute, but would hardly cause diarrhoea with blood. Usually, food poisoning caused by bacteria does not manifest itself immediately, but takes an incubation period of two to 12 hours to manifest itself, normally with acute diarrhoea and vomiting, but not the passage of blood. 

Another possibility is chemical poisoning, which also has an immediate effect, but it is unusual for chemical poisoning to cause severe intestinal bleeding. Food poisoning with

immediate intestinal bleeding could only have been caused by corrosive chemicals such as strong acids, which can easily lead to immediate illness. But corrosive chemicals should havecaused bleeding in the upper intestinal tract, leading to vomiting blood. None of these severe signs are mentioned in the text.

Peptic ulcer diseases can be excluded from the list of possible illnesses as well. In spite of the fact that their onset is immediate, they are seldom accompanied by bloody stool. A gastric ulcer with intestinal bleeding produces blackstool when the ulcer penetrates a blood vessel. An ulcer higher up in the digestive tract would be more likely to manifest itself as bloody vomiting, not a passage of blood through the rectum.

Other evidence against this possibility is that a patient witha large gastric ulcer usually does not have an appetite. By accepting the invitation for lunch with the host, we can assume that the Buddha felt as healthy as any man in his early80s would feel. Given his age we cannot rule out that the Buddha did not have a chronic disease, such as cancer or tuberculosis or a tropical infection such as dysentery or typhoid, which could have been quite common in the Buddha's time. 

These diseases could produce bleeding of the lower intestine, depending on their location. They also agree with the history of his earlier illness during the retreat. But they can be ruled out, since they are usually accompanied by other symptoms, such as lethargy, loss of appetite, weight loss, growth or mass in the abdomen. None of these symptoms were mentioned in the sutta.

A large haemorrhoid can cause severe rectal bleeding, but it is unlikely that a haemorrhoid could cause severe abdominal pain unless it is strangulated. But then it would have greatlydisturbed the walking of the Buddha to the house of his host, and rarely is haemorrhoid bleeding triggered by a meal.

Mesenteric infarction

A disease that matches the described symptoms-accompanied by acute abdominal pain and the passage of blood, commonly found among elderly people, and triggered by a meal-is mesenteric infarction, caused by an obstruction of the blood vessels of the mesentery. It is lethal. Acute mesenteric ischaemia (a reduction in the blood supply to the mesentery) is a grave condition with a high rate of mortality.

The mesentery is a part of the intestinal wall that binds the whole intestinal tract to the abdominal cavity. An infarction of the vessels of the mesentery normally causes the death of the tissue in a large section of the intestinal tract, which results in a laceration of the intestinal wall. 

This normally produces severe pain in the abdomen and the passage of blood. The patient usually dies of acute blood loss. This condition matches the information given in the sutta. It is also confirmed later when the Buddha asked Anandato fetch some water for him to drink, indicating intense thirst. 

As the story goes, Ananda refused, as he saw no source for clean water. He argued with the Buddha that the nearby stream had been muddied by a large caravan of carts. But the Buddha insisted he fetch water anyway. 

A question arises at this point: Why did the Buddha not go to the water himself, instead of pressing his unwilling attendantto do so? The answer is simple. The Buddha was suffering from shock caused by severe blood loss. He could no longer walk, and from then to his death bed he was most likely carried on astretcher. 

If this was indeed the situation, the sutta remains silent about the Buddha's travelling to his deathbed, possibly because the author felt that it would be an embarrassment for the Buddha. Geographically, we know that the distance between the place believed to be the house of Cunda and the place where the Buddha died was about 15 to 20 kilometres. It is notpossible for a patient with such a grave illness to walk such a distance. 

More likely, what happened was that the Buddha was carried on a stretcher by a group of monks to Kusinara (Kushinagara). 

It remains a point of debate whether the Buddha really determined to pass away at this city, presumably not much larger than a town. From the direction of the Buddha's journey, given in the sutta, he was moving north from Rajagaha. It is possible that he did not intend to die there, but in the town where he was born, which would have taken a period of three months to reach.

From the sutta, it is clear that the Buddha was not anticipating his sudden illness, or else he would not have accepted the invitation of his host. Kusinara was probably thenearest town where he could find a doctor to take care of him.It is not difficult to see a group of monks hurriedly carryingthe Buddha on a stretcher to the nearest town to save his life.

Before passing away, the Buddha told Ananda that Cunda was notto be blamed and that his death was not caused by eating Sukaramaddava. The statement is significant. The meal was not the direct cause of his death. The Buddha knew that the symptom was a repeat of an experience he'd had a few months earlier, the one which had almost killed him.

Sukaramaddava, no matter the ingredients or how it was cooked,was not the direct cause of his sudden illness.

Progression of the disease

Mesenteric infarction is a disease commonly found among elderly people, caused by the obstruction of the main artery that supplies the middle section of the bowel-the small intestine-with blood. The most common cause of the obstructionis the degeneration of the wall of the blood vessel, the superior mesenteric artery, causing severe abdominal pain, also known as abdominal angina.

Normally, the pain is triggered by a large meal, which requires a higher flow of blood to the digestive tract. As theobstruction persists, the bowel is deprived of its blood supply, which subsequently leads to an infarction, or

gangrene, of a section of the intestinal tract. This in turn results in a laceration of the intestinal wall, profuse bleeding into the intestinal tract, and then bloody diarrhoea.

The disease gets worse as the liquid and content of the intestine oozes out into the peritoneal cavity, causing peritonitis or inflammation of the abdominal walls. This is already a lethal condition for the patient, who often dies dueto the loss of blood and other fluid. If it is not corrected by surgery, the disease often progresses to septic shock due to bacterial toxins infiltrating the blood stream.

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 superior 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, and this site became the originof the bleeding. Arteriosclerosis, the hardening of the vesselwall caused by ageing, was the cause of the arterial occlusion, a small blockage that did not 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 drinkingto 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 Cundawas 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 ifsanghati nf.According to Buddhist monastic discipline, a ifsanghati nfis acloak, or extra piece of robe, very large, the size of a bed sheet, which the Budd ha 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 tofan 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. Mostof 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 hisbed, 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 tohave 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 thatbrought an end to his life./.

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

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