Abstract
The cause of the Buddha's death remains unknown. This article investigates the symptoms and signs depicted in the Mahaparinibbanasuttanta in order to analyse the situation in the months before he died. It is, however, unknown whether this text is old or is a later interpolation, though many of the symptoms and signs described lead us toward a diagnosis. He suffered from severe pain and bloody diarrhea shortly after he ate sukara-maddava which had been prepared by his generous host, Cunda. Before eating, he felt something was wrong with the food but he ate some. Afterwards he made his host bury the leftovers in a pit. His bloody diarrhea continued, and he often asked for water, indicating intense thirst and dehydration. He continued to travel on foot, and died at Kusinara about 20 Km away from Cunda's house. Most studies on the cause of his death have focused on what sukara-maddava was; whether it was soft pork, mushrooms, or something else. There are many diseases that bring on bloody diarrhea, such as infectious colitis, ischemic colitis including mesenteric infarction, colon cancer, peptic ulcer disease, ulcerative colitis, Crohn's disease, or colonic diverticulosis. All diseases apart from infectious colitis can be excluded due to the Buddha's age, symptoms and signs, clinical course and the bloody stool. Mettanando has recently reported that the Buddha most likely suffered from mesenteric infarction caused by an occlusion of the superior mesenteric artery. However, I think this possibility can be ruled out as the Buddha did not vomit in the early stage of the illness and had no pre-existing diseases, such as heart disease, arrhythmia, etc. If he suffered from severe diseases, such as mesenteric infarction, he would not have continued to travel on foot. So I suspect his illness was severe infectious colitis accompanied by acute onset after his rainy season retreat and fever caused by sukara-maddava, whatever it was, or drinking water contaminated with bacteria, namely dysentery, which would have been common in ancient India.
