Hospitals in ancient Sri Lanka

by Prof W . I.  Siriweera (Summary of a guest lecture delivered at the sixth International Medical Congress organised by the Peradeniya Medical School Alumni Association and the Faculty of Medicine.)- Daily News Wed Apr 2 2003

The archaeological evidence as well as references in chronicles and literature indicate the existence of four types of hospitals during the period of the Rajarata civilisation. Their gradual growth cannot be traced in stages but it is certain that towards the late Anuradhapura period they had attained a fairly advanced stage.

These hospitals can be broadly divided into four categories viz: (a) monastic hospitals where in-house treatment was provided for ailing monks for short or long periods; (b) hospitals for laymen where inhouse treatment was provided (c) maternity homes and (d) hospitals where only outdoor treatment was provided.

Of these substantial amount of archaeological data is available pertaining to hospitals attached to monasteries. The remains of hospitals at Mihintale, Anuradhapura, Madirigiriya, Dighavapi and Dombegoda near Maligavila can be dated to the late Anuradhapura period. Those of the hospital at the Alahana Parivena Complex at Polonnaruwa can be assigned to the twelfth century. Besides these, the chronicle refers to a hospital for monks outside the city of Anuradhapura constructed by the Commander-in-chief of the army during the reign of Mahinda IV (956-972).

The restored foundation indicates that the Mihintale hospital was a 68.6m x 38.1m rectangular building. The main entrance to the building was in the south. As one enters the building on the right hand side there is a 5.18m x 4.27m room. This may have been used as a dispensary. The large hall seems to have been the waiting hall for the patients.

To the left and north of this hall are two rooms presumably used for examining patients. Beyond was the inner court at the center of which are found signs of an image house. Around the inner court was a corridor leading to 32 residential rooms for inhouse patients.

Each of these measures 3.96m x 3.96m. The doors of all these rooms have been placed facing the image house. Presumably the resident monks meditated around the image house in the mornings and evenings. To the north-east of the building is a stone paved room where a medicinal trough externally measuring 213 x 74 x 60 centimeters used for immersion therapy was placed.

This room could be entered through a door from the eastern corridor near rooms of the patients as well as from outside the building through a door in the east. There had also been a jantaghara or a room where steam and hot water therapy was administered in the hospital building. The remains of a separate building which could be the kitchen of the hospital are visible in the northern side beyond the hospital.

Pieces of two large containers have been found in excavations done in 1954 at the Mihintale hospital complex. These pieces have been fitted together and the containers which are of West Asian origin are now displayed at the Anuradhapura museum. As some cement paste had been applied on the interior of these containers to make them air-tight it can be reasonably concluded that they had been used to store medicines at the hospital. Unfortunately the exact location in the hospital where these have been excavated have not been recorded. If it had been done so the identification of the storage room in the hospital could have been easier.

The remains of the ancient Madirigiriya hospital are found about 50 meters to the north of the famous Madirigiri vatadage in Tamankaduwa in the Polonnaruwa district. This hospital is small in size when compared with the one at Mihintale.

The foundation which has been restored suggests that it was a 15.8m x 15.8m square building. Encircling the centre court of the building is a corridor and beyond that are rooms of the inmates. The stone trough used for immersion therapy is now kept near the image house about 67 meters to the north of the hospital. The trough has been removed there by the Department of Archaeology for safekeeping.

The external length of the trough is 230  centimetres and the breadth is 64 centimetres. The height is 58 centimetres.

Near the Thuparama Stupa at Anuradhapura vestiges of a yet another hospital with a medicinal trough in situ are visible. As at the Madirigiriya hospital here too the main entrance is through a door located in the eastern side of the building. The foundation of the building has not been preserved well but existing remains indicate that as at Mihintale, a centre court around an image house and rooms for inmates were important aspects of this hospital as well.

The Ruvanvali Stupa complex contains remains of another hospital attached to the Mahavihara. The distance from the outer wall of the stupa to the hospital is approximately 46 meters. The stone medicinal trough (externally measuring cm. 224 x 75 x 60) found in situ is identical with that of the Thuparama hospital and there are signs of an image house and rooms for inmates. However the area is full of various other ruins belonging to different eras and therefore a correct picture of the plan of the hospital has not emerged so far.

The foundations of the hospitals at Dighavapi and Dombegoda have not been preserved well. But the layout of the hospital at the Alahana Parivena Complex at Polonnaruwa has been restored by the Cultural Triangle in 1982. The restorations indicate that it was smaller in size than the Mihintale Hospital. The total length of the building is 44.8 meters.

The breadth is 33.3 meters. The rooms of inmates are of varying sizes and each of them seems to have accommodated a number of inmates. There had been an image house at the center of the courtyard facing these rooms. Unlike in other hospitals, the baths and toilets for the inmates had been constructed just adjoining their rooms.

There had been two entrances to the hospital from the east and the south. The southern door led into a 9 x 4 meters room. The stone trough externally measuring 248 x 80 x 56cm. had been placed on the left of the room. The granite paved ground of this room has been sloped towards the north and water that led from it has been diverted into a drain.

The stone trough is slightly different from those at Mihintale and Anuradhapura but bears a close resemblance to the one at Medirigiriya. Not only the cavity in which a patient was laid but also the complete granite structure has been scooped out in the form of a human being both at Medirigiriya and Polonnaruwa.

Several common features are discernible in all these hospitals. Walls had been erected around all of them so that they were isolated from the rest of the buildings in the monastic complexes. All the hospitals had been located in easily accessible plains. Similarly constructions have been designed to allow maximum ventilation in the buildings.

As stated earlier there is a dearth of archaeological material pertaining to hospitals for laymen. A reference in the Mahavamsa suggests that there were eighteen hospitals at the time of Dutthagamani (161-137 B.C.). The chronicle also refers to the construction of hospitals in the reigns of Buddhadasa (337-365 A.D.), Upatissa I (365-406 A.D.), Mahanama (406-428 A.D.), Dhatusena (455-473 A.D.), Udaya I (797-801 A.D.), Sena I (833-853 A.D.), Sena II (853-887 A.D.), Kashyapa IV (898-914 A.D.), Kashyapa V (914-923 A.D.), Mahinda IV (956-972 A.D.) and Parakramabahu I (1153-1186 A.D.). The inscriptional evidence confirm some of these constructions.

The Kukurumahandamana Pillar inscription datable to the reign of Kashyapa IV refers to immunities granted to a land belonging to the hospital built by the Commander in Chief named Sen near the Ceremonial Street of the inner city of Anuradhapura. A slab inscription found at Abhayagiriya datable to the reign of Kashyapa V refers to a royal hospital (Rajvedhala) built by the king along the same street.

The Dorabavila Pillar inscription mentions grants made to the same hospital. It is reasonable to conclude that at least some of the above mentioned hospitals were residential hospitals for laymen.

The sources contain several references to maternity homes. The Pandukabhaya legend of the Mahavamsa refers to the construction of a building known by the term Sivikasala. According to the Vamsatthappakasini, the commentary of the Mahavamsa, it was either a hall where a Siva Linga had been placed or a maternity home.

This indicates that at the time of the writing of the Mahavamsa, there had been state maternity homes. Nevertheless references in the chronicles and literature to ordinary women or royal princesses ordinary women or royal princesses entering lying in homes (vijayanaghara, timbirige) should not be construed to mean that they entered common maternity homes for confinement.

The tradition of segregating the expectant mother on the eve of delivery, in a dark room of her own house, which was prevalent in ancient Sri Lanka continues in rural areas even at present. Moreover, it is most unlikely that in semi feudal ancient society the expectant princesses of royal households were sent to common maternity homes for giving birth to children.

Nevertheless there are at least two references which clearly point to the existence of public maternity homes in the country. The chronicle mentions the construction of maternity homes, Pasavantinamsala by king Upatissa I (365-406 A.D.). An inscription set up during the reign of Kashyapa IV (898-914 A.D.) refers to the construction of a maternity home (timibirige) by Senal Nakan, Chief Secretary of the state. According to this inscription several plots of land from an area to the north of Anuradhapura had been allocated for the upkeep and maintenance of this maternity home.

There were several places where treatment was provided for outdoor patients. Some of the hospitals erected by kings and key officials, referred to in the chronicles and inscriptions would have been hospitals for out-patients. Even hospitals to which patients were admitted for treatment consisted of out-patients' divisions as well. These establishments for dispensing medicine were known by the term behetge.

The Kiribatvehera Pillar inscription belonging to the reign of Kashyapa IV (898-914 A.D.) records donations made to a dispensary (behetge) named Bamunu Kumbara. The Vessaagiri Slab inscription of Dappula IV (924-935) too contains some information on a behetge.

Archaeological remains at Arankale monastery in the vicinity of Hiripitiya close to Wariyapola suggests the existence of a large out-door patients' hospital, possibly datable to the late Anuradhapura period. The length of the foundation of this hospital which has been restored is 26.1 meters. Its breadth is 12.2 meters.

Unlike in the hospitals at Mihintale, Medirigiriya etc. Here are no signs of the existence of rooms for inmates or of a medicinal trough in this location. On the other hand large grinding stones, pestles used horizontally and vertically and nearly sixty furnaces or kilns in situ suggests that Arankale behetge was a place where medicines were prepared and dispensed to a large number of outdoor patients and perhaps to dispensaries around the country. Grinders are wasted in the middle suggesting their use for a long time.